Eyelid Malignancies- Always Quite Challenging

Case report: Improving quality of life through hyaluronic acid-based fillers after orbital cancer treatment

Background

Myoepithelial carcinoma is a very rare yet aggressive tumor in children. Surgical intervention and local radiotherapy often lead to post-therapy complications, affecting both the aesthetic and functional quality of life in survivors. Hyaluronic acid (HA) dermal fillers offer a minimally invasive option to improve the appearance and quality of life for these patients once they are declared tumor-free.

Case presentation

We present the case of an 18-year-old girl with a history of myoepithelial carcinoma in the right upper orbit, diagnosed at the age of 8. The patient underwent surgery to remove the tumor and lacrimal gland, followed by chemotherapy and radiotherapy. A complete response to treatment was achieved, and the patient was monitored with regular clinical and radiological exams for 5 years, after which she was declared tumor-free and followed for late effects of therapy. Post-surgical radiotherapy resulted in atrophy of the upper orbital frame and functional complications. The patient exhibited upper eyelid retraction, ptosis, continuous lacrimation, and conjunctival redness. Ten years after treatment, the patient underwent dermal filler injections using Aliaxin® Essential Volume (AEV) and Aliaxin® Superior Volume (ASV) to address the aesthetic impairment of the upper right orbit. ASV was administered using a 22G x 50mm cannula on the periosteum of the superior orbital frame, entering from the outer canthus. AEV was injected with a cannula into the muscle, also entering from the outer canthus. Before treatment, the patient exhibited upper eyelid retraction, ptosis, continuous lacrimation, and conjunctival redness. Following the injections, improvements were observed in all pre-treatment symptoms. The closing ability of the upper eyelid was restored, along with superior orbital volume and symmetry. Enhanced eyelid function improved eye hydration, reduced redness in the conjunctiva, and led to better vision and overall quality of life.

Conclusion

To our knowledge, this is the first reported case of using dermal fillers to treat ocular changes resulting from cancer treatment. Injections of AEV and ASV provided both aesthetic and functional improvements.

Eyelid carcinomas: Tumor aggressiveness tendencies for smokers compared to non‑smokers

During the past few years, several studies have demonstrated that head and neck carcinomas present more aggressive forms for smokers, relative to non-smokers. Our aim was to investigate the tumor aggressiveness for patients with eyelid carcinomas, in relation to tobacco consumption, as well as other demographic and clinical data. For 98 patients with eyelid carcinomas, we studied the relationship between the duration of their symptoms and their tumor stage at first diagnosis, trying to determine potential correlations with smoking status and several other clinical parameters. Our data revealed that, for the same duration of symptoms, tobacco consumers tended to have higher tumor stages, which did not correlate with other variables. For early diagnosed tumors, within the first year of symptoms, smokers presented 6.044 times higher odds to exhibit more advanced tumor stages, compared to non-smokers, and this value decreased to 4.501, up to 5 years of the presence of symptoms (P<0.05). We also noted that, for smokers, an increased age was associated with increased tumor stages, which was opposed to non-smokers, regardless of their symptom duration [average odds ratio (OR) 1.122, P<0.05]. Tumor aggressiveness was therefore associated with tobacco consumption, leading to an increased risk of developing more aggressive forms of eyelid carcinomas for smokers, compared to non-smokers.

Challenging eyelid reconstruction in malignancies: Case reports

Eye is one of the most crucial organs in need of protection. The most important function of eyelids is designed to protect the eyeball. Despite their small and thin surface area, they are among the most sunlight-exposed area of skins, hence, it is prone to develop eyelid tumors. As the malignant tumors have the tendency of growing aggressively and have a high mortality, we have to meticulously remove the lesion along with its surrounding tissue, if needed, to ensure the clearance of tumor margin. To strike a suitable outcome between the cosmetic and function after tumor removal is a quite challenging task. Compromise on aesthetics and eyelids' indispensable function of protecting the eyes during management, may lead to unfavorable cosmetic deformity and loss of vision. Therefore, it is imperative that wise selection of appropriate techniques be discussed and managed accordingly. In this article, the authors reported two case scenarios of eyelid reconstruction which was performed to show the management of full-thickness defect after removal of the malignant neoplasms. Skin flaps and graft technique used to reconstruct the eyelid in each patient was different to emphasize that eyelid malignancies require an individualized management.

Impact of the type of anterior lamellar reconstruction on the success of modified Hughes procedure

PURPOSE

To determine the long-term functional and cosmetic outcomes in patients who underwent modified Hughes procedure with different types of anterior lamellar reconstruction for lower eyelid defects.

METHODS

This study included 58 patients who had undergone a modified Hughes flap for reconstruction of lower eyelids after tumor excision within a 10-year period. Data regarding patient demographics, size of eyelid defect, tumor pathology, surgical techniques, functional and cosmetic outcomes, and complications were recorded. Postoperative complications were evaluated according to the type of anterior lamella reconstruction (i.e., advancement flap or free skin graft). Multivariate logistic regression analysis was performed to identify risk factors affecting the success of the procedure.

RESULTS

The average size of the lower eyelid defect was 22 ± 6.3 mm (range: 11-30 mm). The anterior lamella was reconstructed with advancement flaps and full-thickness skin grafts in 36 (58.6%) and 24 (41.4%) patients, respectively. Mean follow-up time was 23.6 ± 11.9 months. Postoperative complications included trichiasis (three patients; 5.2%), ectropion (two patients; 3.0%), flap necrosis (one patient; 1.7%), flap dehiscence (one patient; 1.7%), infection (one patient; 1.7%), and eyelid margin erythema (one patient; 1.7%). The rates of complication and secondary surgery were similar among the different types of anterior lamellar reconstruction (p=768 and p=0.139, respectively). Success of the modified Hughes procedure was not significantly affected by any of the identified risk factors (p>0.05). Functional and cosmetic outcomes were 96.6% and 94.8%, respectively.

CONCLUSION

Modified Hughes procedure is a safe and effective option for the reconstruction of small and large defects of the lower eyelid, regardless of the type of anterior lamella reconstruction (i.e., advancement flap or skin graft).