Therapiealternativen zur chirurgischen Versorgung maligner Lidtumoren und deren Vorläuferstufen

[Ophthalmic oncology in a warmer world: climate-related increase in the prevalence of eyelid cancer]

BACKGROUND

Damage induced by ultraviolet (UV) radiation plays a decisive role in the carcinogenesis of malignant tumors of the eyelids.

METHODS

A selective literature search was performed in PubMed and Google Scholar.

RESULTS

Large epidemiological studies show an increase in the prevalence of eyelid tumors in recent decades. The incidence of malignant eyelid tumors has increased especially in the white population over the last 70 years. A UV-induced damage to tumor suppressor genes and oncogenes which play a key role in the carcinogenesis of malignant eyelid tumors has been demonstrated. Strong intermittent UV exposure and sunburn have been identified as risk factors for basal cell carcinoma and malignant melanoma. For squamous cell carcinoma, cumulative UV exposure over a longer period of time is considered a risk factor.

CONCLUSION

In order to counteract the UV-related increase in malignant eyelid tumors, preventive protective measures, early detection and increased public awareness are essential. On the one hand, changes in behavior, appropriate clothing, wearing hats and sunglasses or contact lenses with UV filters are effective measures for UV protection. On the other hand, the underlying mechanisms of carcinogenesis should be investigated further in order to be able to carry out effective prevention and further develop treatment.

Plasma Exeresis for the Treatment of Benign Eyelid Lesions: A New Surgical Approach

PURPOSE

To report the plasma therapy technique and its clinical outcomes in patients with benign eyelid lesions.

METHODS

This is a retrospective, noncomparative, interventional study. The study included 71 eyes of 66 patients who underwent plasma exeresis for benign eyelid lesions in our clinic between February 2018 and December 2022. Patient symptoms, cosmetic outcomes, and complications were evaluated.

RESULTS

The lesions were removed with a single plasma exeresis treatment in all patients. The mean size of the lesion at its largest part was 5.5 ± 1.2 mm (range, 3.0-8.8 mm). No complications were encountered during the procedure. The mean procedure time was 4.0 ± 0.7 minutes (range, 3-6 minutes). Postoperatively, only 3 cases (4.2%) with tarsal conjunctival extension had mild irritation symptoms such as pain, discomfort, and redness. The treated areas were fully improved cosmetically, and all patients were satisfied with the cosmetic outcomes.

CONCLUSIONS

The plasma therapy technique for removing benign eyelid lesions offers minimally invasive surgery, less discomfort, fast recovery, and successful anatomical and cosmetic outcomes.

Long-term efficacy and safety of imiquimod 5% and fluorouracil 1% creams in medical monotherapy of complex eyelid basal cell carcinomas

PURPOSE

To study the long-term efficacy and safety of local application of imiquimod 5% and fluorouracil 1% creams in complex eyelid basal cell carcinomas (BCCs).

METHODS

A retrospective, non-comparative study in biopsy-proven, complex (involving canthi or >50% of eyelid length) eyelid BCC patients who were medically unfit for surgical procedures. All patients were medically treated with either of the creams using fixed-dose regimens for a minimum of 3 months. All received oral vitamin C 500 mg QID for 3 months as an adjunct for collagen healing. A minimum of "post-treatment" follow-up of 12 months was observed.

RESULTS

Of total 30 patients, imiquimod 5% and fluorouracil 1% were used in 16 and 14 patients, respectively. The mean age of our patients was 70.5 years. The co-morbidities included - severe coronary artery disease using blood-thinners (n = 19), poorly controlled diabetes (n = 12), poorly controlled hypertension (n = 6), on nebulization (n = 3), and tuberculosis with pulmonary fibrosis (n = 2). Complete clinical tumor resolution was noted in 10 and 8 patients over 12 and 16.5 weeks, respectively, in imiquimod and fluorouracil groups. Periocular skin erythema, chemical conjunctivitis, and skin depigmentation were seen in all the patients of imiquimod group. On the other hand, the local side-effect profile in fluorouracil patients was limited.

CONCLUSION

The medical treatment of complex eyelid BCC is a useful alternative to surgery in the elderly with significant co-morbidities. It provides a promising long-term relief with a tolerable side-effect profile. A prospective, randomized, double-blinded trial would provide stronger evidence for the efficacy of these drugs.