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Actis AG, Actis G, De Sanctis U, Fea A, Rolle T, Grignolo FM. Eyelid benign and malignant tumors: issues in classification, excision and reconstruction. MINERVA CHIR 2013; 68:11-25. [PMID: 24172760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
In the orbital region the variety of tumors is so vast that even an expert oculoplastic surgeon may be deceived. The various tumors may be classified as benign, precancerous and malignant. Approximately 5-10% of all skin cancers occur in the eyelids. Incidence studies indicate that basal cell carcinoma is the most frequent malignant eyelid tumor, followed by squamous cell carcinoma, sebaceous gland carcinoma and malignant melanoma. Malignant neoplasms represent the leading cause of plastic reconstruction in orbital region, followed by cicatricial retraction, post-traumatic loss of tissue, congenital colobomas. Aim of this review is to classify benign and malignant lesions; to consider the surgical removal approach to the lesion (Mohs micrographic surgery, frozen sections, biopsy, immediate removal and reconstruction with permanent sections) and finally to consider reconstruction techniques with grafts and flaps.
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Affiliation(s)
- A G Actis
- Department of Surgical Sciences, Eye Clinic Doctoral School in Life and Health Sciences University of Turin, Turin, Italy -
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Grusha IO, Ismailova DS, Rizopulu ÉF. [Eyelid reconstruction after full-thickness resections in benign and malignant tumors]. Vestn Oftalmol 2013; 129:46-51. [PMID: 23808180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Full-thickness eyelid defect closure requires appropriate reconstruction, function recovery and acceptable cosmetic result. The aim of the study was to study the results of eyelid reconstruction after full-thickness resections in different benign and malignant tumors. 241 patients (63,5% females, 36,5% males) who underwent full-thickness resectioh of the lower or the upper eyelid due to tumor with primary defect closure were enrolled in the study. Eyelid resection was performed within visually clear tissue 2 mm away of the tumor border in benign and at least 3 mm in malignant lesions. Presented results of different techniques of eyelid reconstruction after full-thickness resections show good functional and cosmetic rehabilitation of patients and low complication rate.
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Esmaeli B, Nasser QJ, Cruz H, Fellman M, Warneke CL, Ivan D. American Joint Committee on Cancer T category for eyelid sebaceous carcinoma correlates with nodal metastasis and survival. Ophthalmology 2012; 119:1078-82. [PMID: 22330966 DOI: 10.1016/j.ophtha.2011.11.006] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2011] [Revised: 11/04/2011] [Accepted: 11/04/2011] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To determine whether T category of the American Joint Committee on Cancer (AJCC) TNM staging system for eyelid carcinoma, 7th edition, correlates with lymph node metastasis, distant metastasis, and survival in patients with sebaceous carcinoma of the eyelid. DESIGN Retrospective, cohort study. PARTICIPANTS Fifty consecutive patients treated by 1 author (BE) for eyelid sebaceous carcinoma between May 1999 and August 2010. METHODS Each tumor was staged according to the AJCC 7th edition TNM criteria. The Kaplan-Meier method was used to determine associations between disease-specific survival and (1) T category at presentation, (2) lymph node metastasis, and (3) distant metastasis. MAIN OUTCOME MEASURES T category at presentation, nodal metastasis, survival. RESULTS The study included 37 women and 13 men (median age, 68.5 years; range, 44-86 years). Forty-four patients were white, 5 were Hispanic, and 1 was Asian. TNM designations were TXN0M0, 7 patients; T1N0M0, 4 patients; T2aN0M0, 12 patients; T2bN0M0, 11 patients; T2bN1M0, 2 patients; T2bN1M1, 1 patient; T3aN0M0, 2 patients; T3aN1M0, 5 patients; T3bN0M0, 1 patient; T3bN1M0, 1 patient; T3bN0M1, 2 patients; T4N0M0, 1 patient; and T4N0M1, 1 patient. T category at presentation was significantly associated with lymph node metastasis (P = 0.0079). No tumors with T category better than T2b or smaller than 9 mm in greatest dimension were associated with nodal metastasis. Five patients (10%) died of disease during follow-up. Their TNM designations were T2bN1M1, 1 patient; T3bN0M1, 2 patients; T4N0M0, 1 patient; and T4N0M1, 1 patient. No tumors smaller than 12 mm in greatest dimension were associated with distant metastasis or death. T category was significantly associated with disease-specific survival (P = 0.0009). Disease-specific survival was poorer among patients with T category of T3a or worse (P = 0.035). CONCLUSIONS T category in the 7th edition of the AJCC TNM staging system for eyelid carcinoma correlates with outcomes in patients with sebaceous carcinoma of eyelid. On the basis of the present findings, it seems reasonable to recommend sentinel lymph node biopsy or at least strict regional lymph node surveillance for patients with eyelid sebaceous carcinoma with tumors of T category T2b or worse or 10 mm or more in greatest dimension.
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Affiliation(s)
- Bita Esmaeli
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Shinder R, Ivan D, Seigler D, Dogan S, Esmaeli B. Feasibility of using American Joint Committee on Cancer Classification criteria for staging eyelid carcinomas. Orbit 2011; 30:202-207. [PMID: 21957948 DOI: 10.3109/01676831003664343] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
PURPOSE To evaluate the feasibility of staging eyelid carcinomas using the American Joint Committee on Cancer (AJCC) criteria, and to compare the 6(th) and 7(th) editions. METHODS The records of 27 consecutive patients who underwent excision of eyelid carcinoma between April 2007 and April 2008 were reviewed. Patients with melanoma, lymphoid tumors, nonmeasurable disease, or medial or lateral canthal tumors were excluded. Each patient was staged using the AJCC 6(th) and 7(th) edition criteria based on clinical, pathologic, and radiographic data. RESULTS The study included 13 men and 14 women aged 32 to 93 years (median, 65 years). Seventeen patients had basal cell carcinoma; 3, squamous cell carcinoma; 6, sebaceous carcinoma; and 1, Merkel cell carcinoma. Tumor location was lower eyelid in 20 patients and upper eyelid in 7. TNM designations were reliably determined for all 27 patients and were: A) using the 6(th) edition: T1N0M0, 6 patients; T2N0M0, 6; T2N1M0, 1; T3N0M0, 4; T4N0M0, 9; and T4N1M0, 1. B) using the 7(th) edition: T1N0M0, 6 patients; T2aN0M0, 8; T2aN1M0, 1; T2bN0M0, 2; T3aN0M0, 6; T3aN1M0, 1; T3bN0M0, 2; and T4N0M0, 1. Pathologic tumor size and nodal status, and systemic work-up were recorded for all patients. CONCLUSIONS Eyelid carcinomas can be reliably staged using the AJCC criteria. There are notable differences between the 6(th) and 7(th) editions of AJCC TNM designation. We recommend AJCC staging using the latest published edition during the initial work-up for all patients with eyelid carcinoma to make reporting of outcomes more reliable and reproducible.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Biopsy, Needle
- Carcinoma, Basal Cell/classification
- Carcinoma, Basal Cell/pathology
- Carcinoma, Basal Cell/surgery
- Carcinoma, Merkel Cell/classification
- Carcinoma, Merkel Cell/pathology
- Carcinoma, Merkel Cell/surgery
- Carcinoma, Squamous Cell/classification
- Carcinoma, Squamous Cell/pathology
- Carcinoma, Squamous Cell/surgery
- Cohort Studies
- Eyelid Neoplasms/classification
- Eyelid Neoplasms/pathology
- Eyelid Neoplasms/surgery
- Feasibility Studies
- Female
- Follow-Up Studies
- Humans
- Immunohistochemistry
- Male
- Middle Aged
- Neoplasm Invasiveness/pathology
- Neoplasm Staging/classification
- Ophthalmologic Surgical Procedures/methods
- Retrospective Studies
- Societies, Medical/standards
- Treatment Outcome
- United States
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Affiliation(s)
- Roman Shinder
- Section of Ophthalmology, Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
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Tsuji H, Tamura M, Yokoyama M, Takeuchi K, Mimura T. Ocular involvement by epstein-barr virus-positive diffuse large B-cell lymphoma of the elderly: a new disease entity in the world health organization classification. ACTA ACUST UNITED AC 2010; 128:258-9. [PMID: 20142557 DOI: 10.1001/archophthalmol.2009.381] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
MESH Headings
- Aged, 80 and over
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Biomarkers, Tumor/metabolism
- Epstein-Barr Virus Infections/classification
- Epstein-Barr Virus Infections/diagnosis
- Epstein-Barr Virus Infections/drug therapy
- Epstein-Barr Virus Infections/virology
- Eyelid Neoplasms/classification
- Eyelid Neoplasms/diagnosis
- Eyelid Neoplasms/drug therapy
- Eyelid Neoplasms/virology
- Female
- Herpesvirus 4, Human/isolation & purification
- Humans
- Lymphoma, Large B-Cell, Diffuse/classification
- Lymphoma, Large B-Cell, Diffuse/diagnosis
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, Large B-Cell, Diffuse/virology
- Magnetic Resonance Imaging
- Orbital Neoplasms/classification
- Orbital Neoplasms/diagnosis
- Orbital Neoplasms/drug therapy
- Orbital Neoplasms/virology
- Positron-Emission Tomography
- World Health Organization
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Abstract
Cutaneous eyelid melanomas are very rare lesions. The lentiginous subtypes are the most frequent melanocytic lesions of the eyelid and can be likened to conjunctival melanocytic lesions like PAM, PAM with atypia and conjunctival melanoma. Compared to melanomas elsewhere on the body, eyelid melanomas have special considerations. Eyelid skin is very thin, the mucocutaneous junction at the lid margin can affect prognosis, the lymphatic drainage pattern is very variable and there is an inherent difficulty to excise wide margins without sacrificing important structures. A customized excision approach, using tissue-sparing "Slow-Mohs" technique, is suggested. Sentinel lymph node dissection has an evolving therapeutic role but remains controversial.
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Affiliation(s)
- Patrick R Boulos
- Oculofacial and Orbit Surgery Service, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA 02114, USA
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Chen RJ, Xiao YQ. [Clinical and pathological analysis of 2734 cases of eyelid neoplasms]. Zhonghua Yan Ke Za Zhi 2008; 44:143-146. [PMID: 18683700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVE To study the histopathological classification and changes of eyelid neoplasms. METHOD In this retrospective case series, the pathological specimens of 2734 cases with eyelid neoplasms examined between 1993-2005 were claimed and analyzed. RESULTS There were 1248 eyelid tumors (45.65%) in 2734 cases with eyelid neoplasms, including 875 benign neoplasms (71.11%) and 960 malignant cases (29.89%). The three leading malignant eyelid tumors were basal cell carcinoma, meibomian gland carcinoma and squamous cell carcinoma The mean ages of the occurrence of these three tumors were 64.16, 63.30 and 60.38 years old, respectively. CONCLUSION Pathologic classification of eyelid neoplasms is helpful for the pathological diagnosis and provides information for the diagnosis and treatment of these diseases.
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Affiliation(s)
- Rong-Jia Chen
- Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai 200032, China.
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Abstract
The clinical aspect of tumors of the eyelids is polymorphous; however, the most frequent are benign tumors such as papillomas, basal cell carcinoma, squamous cell carcinoma, meibomian gland carcinoma, and melanomas. An important step in the management of the malignant types is to try to establish clear margins through histopathologic techniques: the Mohs technique, the rapid fixation technique, and the frozen section method are the most frequent technical tools used today. For the most malignant tumors such as malignant melanoma and Merkel cell tumor, lymph sentinel biopsy is a recent, valuable tool, but its benefit needs to be confirmed in large series.
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Affiliation(s)
- J P Adenis
- Service d'Ophtalmologie, CHU Dupuytren, 2, avenue Martin Luther King, 87042 Limoges CEDEX
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Abstract
A broad spectrum of lymphomas can affect the eye and orbital tissues. This article discusses those that affect the orbit, lids, lacrimal gland, and conjunctiva.
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Affiliation(s)
- David S Bardenstein
- Ocular Oncology Service, Department of Ophthalmology and Pathology, Case-Western Reserve University School of Medicine, 11100 Euclid Avenue, Cleveland, OH 44106, USA.
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Nola M, Lukenda A, Bollmann M, Kalauz M, Petrovecki M, Bollmann R. Outcome and prognostic factors in ocular adnexal lymphoma. Croat Med J 2004; 45:328-32. [PMID: 15185428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
Abstract
AIM To classify ocular lymphomas in patients treated at the Zagreb University Hospital Center according to the new classification of the World Health Organization (WHO) and to determine factors with prognostic significance. METHODS From 1986 to 2003, histological diagnosis of ocular lymphoma was made in 24 patients. The median age of patients was 62 years, with 2:1 female predominance. The patients underwent staging procedures and clinical evaluations prior to the date of the initial therapy. Histopathologic slides were reviewed and tumors were classified according to the new WHO classification. Additional immunohistochemical studies were performed on 35 available specimens. The antibodies used were CD3, CD5, CD10, CD20, CD43, and bcl-6; and in a few cases cyclin D1, bcl-2, CD23, CD79a, and CD138. The main outcome measures were development of distant recurrence after new presentation with solely ocular adnexal disease, and death attributable to widespread lymphoma. RESULTS Ocular adnexal lymphomas were found in orbit in 20 patients, in eyelid in two, and conjunctiva in two patients. Twenty patients had lymphoma stage IE, one had IIE, and three had stage IV. Three patients had prior or concurrent systemic disease and 21 patients had primary lymphoma. The main subtypes of non-Hodgkin lymphoma according to the WHO classification were extranodal marginal zone B-cell lymphoma (n=20), diffuse large cell B-cell lymphoma (n=2), mantle cell lymphoma (n=1), and plasmacytoma (n=1). Six lymphomas were CD43 positive and five of them were extranodal marginal zone B-cell lymphomas. Radiotherapy was given to 11 patients, chemotherapy in 8 patients, whereas radiotherapy and chemotherapy were implemented in three patients. Two patients underwent only surgical excision of the tumor. Local relapse was found in three and distant recurrence in four patients. Distant recurrence was found in four patients with stage IE (two of them also had a local relapse). In the group of patients with extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue (B-EMZL), the estimated 5-year overall survival was 92.9+/-6.6% (mean+/-standard deviation) and the 5-year failure-free survival was 80.1+/-10.3%. Age, sex, side of involvement, anatomic localization of the lesion, clinical stage of disease, and mode of therapy did not have any prognostic significance during the follow-up period (median, 53; range, 9-131 months). Immunohistochemical marker CD43 was the only parameter of prognostic significance (p=0.035). Patients with B-EMZL had almost 14 times higher chance for an unfavorable outcome if the tumor cells expressed CD43 on their surface, than the CD43-negative cases. CONCLUSION Most ocular adnexal lymphomas usually have a B-cell immunophenotype, the morphologic and immunohistochemical features of extranodal marginal zone B-cell lymphoma, and a favorable prognosis. Our data suggest that CD43 could be useful to separate the group of patients with extranodal marginal zone B-cell lymphomas with unfavorable prognosis from those that have a good prognosis. CD43 positive ocular lymphomas are associated with a higher rate of subsequent distant recurrence and the rate of lymphoma-related death.
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Affiliation(s)
- Marin Nola
- Department of Pathology, Zagreb University School of Medicine, Salata 10, 10000 Zagreb, Croatia.
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Coupland SE, Hellmich M, Auw-Haedrich C, Lee WR, Stein H. Prognostic value of cell-cycle markers in ocular adnexal lymphoma: an assessment of 230 cases. Graefes Arch Clin Exp Ophthalmol 2003; 242:130-145. [PMID: 14685876 DOI: 10.1007/s00417-003-0831-5] [Citation(s) in RCA: 80] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2003] [Revised: 11/18/2003] [Accepted: 11/19/2003] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND To determine the prognostic value of cell-cycle associated markers in ocular adnexal lymphoma (OAL). METHODS Two hundred sixty-one consecutive cases of ocular adnexal lymphoproliferative lesions were subdivided into reactive lymphoid hyperplasia (RLH), atypical lymphoid hyperplasia (ALH) and OAL. The latter were sub-typed according to the new WHO Lymphoma Classification. All lesions were investigated applying standard immunohistochemical methods with antibodies specific for pRB, p53, p16, p21, BCL-6 and for multiple myeloma oncogene-1-protein (MUM1, also known as IRF4). The main endpoints included the development of a local recurrence, of systemic disease and of lymphoma-related death. The association of prognostic variables with endpoints was assessed by multiple logistic and Cox regression models, respectively. RESULTS The ocular adnexal lymphoproliferative lesions were categorised as OAL ( n=230; 88%), RLH ( n=29; 11%), and ALH ( n=2; 1%). The major lymphoma subtypes included 136 extranodal marginal zone B-cell lymphoma (EMZL), 31 diffuse large cell B-cell lymphomas, 27 follicular lymphomas, 9 plasmacytomas, 9 lymphoplasmocytic lymphoma/immunocytomas and 8 mantle cell lymphomas. The median follow-up time was 44.5 months. Most OAL patients had Stage IE disease and were treated with radiotherapy. Thirty-seven (25%) Stage IE patients had tumour relapses: these were significantly associated with an increased BCL6 blast percentage. Sixty-two (42%) Stage IE patients developed systemic disease: they had "non-EMZL" with large growth fractions and increased blast percentages for BCL6. Fifty-seven (25%) OAL patients died because of their lymphoma; lymphoma-related death was significantly associated on multivariable analysis with advanced clinical stage, an age >60 years and large tumour growth fractions. CONCLUSION Subtyping of OAL according to the new WHO Lymphoma Classification, the stage of disease and tumour cell growth fraction aided the prediction of (1) tumour relapse, (2) the development of systemic disease and (3) lymphoma-related death in OAL.
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Affiliation(s)
- Sarah E Coupland
- Department of Pathology, University Hospital Benjamin Franklin of the Free University, Hindenburgdamm 30, 12200, Berlin, Germany.
| | - Martin Hellmich
- Department of Medical Statistics, Informatics and Epidemiology, University of Cologne, Cologne, Germany
| | | | - William R Lee
- Department of Pathology, Western Infirmary, Glascow, Scotland
| | - Harald Stein
- Department of Pathology, University Hospital Benjamin Franklin of the Free University, Hindenburgdamm 30, 12200, Berlin, Germany
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Esmaeli B, Youssef A, Naderi A, Ahmadi MA, Meyer DR, McNab A. Margins of excision for cutaneous melanoma of the eyelid skin: the Collaborative Eyelid Skin Melanoma Group Report. Ophthalmic Plast Reconstr Surg 2003; 19:96-101. [PMID: 12644753 DOI: 10.1097/01.iop.0000056141.97930.e8] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the practice patterns among surgeons who treat melanomas of the eyelid skin with respect to margins of excision and to look for possible correlation between margins of excision and the incidence of local and regional recurrence and distant metastasis. METHODS A retrospective survey of the members of the American Society of Ophthalmic Plastic and Reconstructive Surgery and the European Society of Ophthalmic Plastic and Reconstructive Surgery yielded 44 cases. The patients' age, sex, date of diagnosis, histologic classification of melanoma, Breslow thickness, Clark level, location of melanoma, size of margins of excision, and findings of local or regional recurrence or distant metastasis were recorded in each case. Patients were stratified on the basis of margins of excision: </=5 mm; >5 mm but <10 mm; and >/=10 mm. Patients were also stratified by Breslow thickness. A Cox regression model was used to evaluate the predictive value of each factor for recurrence. Main outcome measures were the incidences of local and regional recurrence and distant metastasis as a function of margins of excision and Breslow thickness. RESULTS The majority of patients for whom reliable information was available had excision margins of </=5 mm. The Breslow thickness of most of the tumors was </=1 mm. Eleven patients (25%) had local recurrence. Five patients (11%) had regional lymph node metastasis. All patients with regional nodal metastasis were men. Distant metastasis developed in 3 patients (7%)-2 men and 1 woman. The follow-up times ranged from 10 to 108 months (mean, 34 months; median, 21 months). The incidence of local recurrence was higher among patients with melanomas at least 2 mm thick and margins of excision </=5 mm than among patients with melanomas at least 2 mm thick but with margins >/=10 mm, but this difference was not statistically significant because very few patients had melanomas at least 2 mm thick. Breslow thickness was the only statistically significant predictor of local, regional, and distant metastasis. Margins of excision did not have a statistically significant effect on local, regional, or distant recurrence. CONCLUSIONS Breslow thickness is an important prognostic indicator for eyelid skin melanomas. A 5-mm margin of excision may be adequate for thin melanomas of the periocular skin, but because of the small number of patients in this series who had >5-mm margins, a definitive comparison of outcome with larger margins of excision cannot be made. For melanomas >/=2 mm, wider margins of excision may be prudent, and careful surveillance for local and regional recurrence is indicated.
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Affiliation(s)
- Bita Esmaeli
- Section of Ophthalmology, Department of Plastic Surgery, University of Texas, M.D. Anderson Cancer Center, Houston, Texas 77030, USA.
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Pluot M, Ducasse A. [Pathology in the diagnosis and treatment of palpebral tumors]. J Fr Ophtalmol 2003; 26:77-83. [PMID: 12610415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
UNLABELLED The authors stress the role and place of pathology in the diagnosis and treatment of eyelid tumors. After a brief report on the main histological characteristics of eyelid tumors and their classification, the pathological methods are described, with particular attention paid to the technical aspects of frozen sections in palpebral surgery. AIM This study reports the main pathological techniques available for use in eyelid tumor surgery. The advantages of frozen sections are reported from a retrospective study of basal-cell carcinomas of the eyelid. MATERIAL AND METHODS All basal-cell carcinomas treated at the Reims Hospital from 1985 to 1999 were retrospectively studied. The pathological aspects are reported. Most of the tumors (155/193) were examined with frozen sections. Recurrences are considered. CONCLUSION Pathology in eyelid tumor surgery must be taken into consideration. Frozen section examination may eliminate recurrences and limit healthy tissue taken at resection. This method is a very useful tool in this type of surgery. The benefits of the classic Mohs technique can be completed by a technique that is more precisely adapted to the control of the lateral limits of the excision in reconstructions which are often complex.
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Affiliation(s)
- M Pluot
- Laboratoire d'Anatomie et de Cytologie Pathologiques, CHR de Reims
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Abstract
OBJECTIVE To study the clinical and histopathologic features of cutaneous eyelid melanomas and identify prognostic factors in the behavior of such tumors. DESIGN Retrospective observational case series. PARTICIPANTS Twenty-three patients with cutaneous eyelid melanomas without conjunctival involvement. METHODS Patients' charts were reviewed for clinical information, treatment procedure, and disease course (updated at the time of study). Histopathologic sections from all surgical procedures were reviewed. MAIN OUTCOME MEASURES Histologic type of melanoma, tumor growth phase, Clark's level of invasion, tumor thickness, and other microscopic features were evaluated in each case. The width of excision margins was considered and measured histologically when possible. RESULTS There was no gender predilection. The lower eyelid was more frequently involved than the upper eyelid or canthi. Seventeen cases (74%) were invasive, and six (26%) were in situ melanomas. Lentigo maligna melanoma was the most common histologic type, accounting for 61% (14 cases) of all melanomas and 53% (9 cases) of invasive melanomas. Superficial spreading melanoma accounted for 22% (5 cases) and nodular melanoma for 17% (4 cases) of all melanomas. Surgical excision, as the treatment of choice, was incomplete in nine cases, two thirds of which were lentigo maligna melanoma (in situ or invasive). Tumor reappeared in 77.8% of these cases. Fourteen patients had initial narrow excisions, and three of them (21.4%) had local recurrences. Although recurrence occurred in one each of our "in situ," "thin," and "thick" melanomas, it proceeded to distant metastases and death only in the "thin" one. Adjuvant radiotherapy was used in six patients with successful disease control in two cases. CONCLUSIONS Eyelid skin melanomas have a relatively good clinical prognosis. The histologic type and thickness of the primary melanoma were not clearly related to the clinical behavior once they were completely excised. The use of very narrow excisions of 5 mm or less was associated with greater frequency of local recurrence. Lentigo maligna melanomas were the largest tumors at presentation and, despite being thinner, were a greater surgical challenge. This type of melanoma is almost certainly underdiagnosed by ophthalmologists.
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Affiliation(s)
- Mojgan Vaziri
- Department of Pathology, Vancouver General Hospital and University of British Columbia, Vancouver, British Columbia, Canada
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Abstract
BACKGROUND This study involved 73 patients with lymphoproliferative lesions of the ocular adnexa. The lesions were categorized using the Revised European American Lymphoma classification of lymphoid tissues and analysed to determine the frequency and prognostic impact of tumour type, location, stage and patient's age and sex. METHODS The clinical, histopathological, immunohistochemical and phenotypic analysis by flow cytometry and follow-up data were studied. RESULTS The ocular adnexal lymphoproliferative lesions included 70 lymphomas and six reactive lymphoid hyperplasia. Seventy-nine per cent had stage IE disease, 4% stage II, 1.5% stage III and 15.5% stage IV. Five patients (7%) had a past history of systemic lymphoma. Major histological types were extranodal marginal zone lymphoma (MZL) in 44 (63%), follicular (FL) in 12 (17%), diffuse large B-cell (DLBCL) in eight (11%), mantle cell (MCL) in two (3%), B-cell chronic lymphocytic leukaemia (CLL)/small lymphocytic lymphoma in two (3%), peripheral T-cell lymphoma (PTCL) one (1.5%) and natural killer cell lymphoma (NKCL) in one (1.5%). Longest survival was seen in those with low-grade lymphomas (MZL and FL) and worst in PTCL and NKCL. Lymphoma-related mortality was 2% for MZL, 33% for FL, 38% for DLBCL, and 100% for MCL, PTCL and NKCL. Systemic lymphoma was present prior to, at presentation or at subsequent follow up in 26/68 (39%) of all lymphoma patients, 17% for MZL, 38% for DLBCL, 83% for FL, and 100% for MCL, CLL, PTCL and NKCL. CONCLUSION The majority of ocular adnexal lymphomas were low-grade B-cell lymphomas (MZL). Multivariate analysis showed that the only significant independent predictors of all causes of mortality were the histological type of lymphoma and the stage of disease at presentation.
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Affiliation(s)
- P A McKelvie
- Department of Anatomical Pathology, St Vincent's Hospital, Fitzroy, Victoria, Australia.
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Affiliation(s)
- J A Shields
- Ocular Oncology Service, Wills Eye Hospital, 900 Walnut Street, Philadelphia, PA 19107, USA
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Lindgren G, Lindblom B, Bratel AT, Mölne L, Larkö O. Mohs' micrographic surgery for basal cell carcinomas on the eyelids and medial canthal area. I. Characteristics of the tumours and details of the procedure. Acta Ophthalmol Scand 2000; 78:425-9. [PMID: 10990045 DOI: 10.1034/j.1600-0420.2000.078004425.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
PURPOSE To analyse the characteristics of eyelid basal cell carcinomas excised using Mohs' micrographic technique. METHODS Sixty-six eyelid basal cell carcinomas were excised using Mohs' micrographic technique. The tumours were classified into four subtypes; morpheiform, intermediate, nodular/micronodular and superficial. Data on previous treatment of the tumours were retrieved. RESULTS Thirty-two tumours (48%) were primary, 8 tumours (12%) were incompletely excised using conventional excision surgery and 26 tumours (39%) were recurrent. Nineteen of the 26 (73%) recurrent tumours and 14 of the 32 (44%) primary tumours were nodular/micronodular. To achieve radical excision, superficial tumours needed an average of 2.0, nodular/micronodular 2.5, intermediate 2.0 and morpheiform tumours 2.9 excisions. CONCLUSIONS Eyelid basal cell carcinomas with ill-defined borders or recurrent tumours are well suited for Mohs' micrographic surgery. The extensions of the tumours are difficult to determine even in some less aggressive subtypes such as superficial and nodular/micronodular basal cell carcinomas.
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Affiliation(s)
- G Lindgren
- Department of Ophthalmology, Göteborg University, Sahlgrenska University Hospital, Sweden
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Coupland SE, Krause L, Delecluse HJ, Anagnostopoulos I, Foss HD, Hummel M, Bornfeld N, Lee WR, Stein H. Lymphoproliferative lesions of the ocular adnexa. Analysis of 112 cases. Ophthalmology 1998; 105:1430-41. [PMID: 9709754 DOI: 10.1016/s0161-6420(98)98024-1] [Citation(s) in RCA: 265] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Lymphoproliferative lesions of the ocular adnexa were analyzed to examine (1) the suitability of the Revised European-American Lymphoma (REAL) classification for the subtyping of the lymphomas in these sites; (2) the predictive value of the REAL classification for the evolution of these tumors; and (3) the frequency and prognostic impact of tumor type, location, proliferation rate (Ki-67 index), p53, CD5 positivity and the presence of monoclonality within these tumors. DESIGN Retrospective review. METHODS The clinical, histomorphologic, immunohistochemical, and molecular biologic (polymerase chain reaction [PCR]) features of lymphoid proliferations of the ocular adnexa were studied. STUDY MATERIALS: The ocular adnexal lymphoproliferative lesions were located as follows: orbit in 52 patients (46%), conjunctiva in 32 patients (29%), eyelid in 23 patients (21%), and caruncle in 5 patients (4%). RESULTS Reactive lymphoid hyperplasia was diagnosed in 12 cases and lymphoma in 99 cases; 1 case remained indeterminate. The five main subtypes of lymphoma according to the REAL classification were extranodal marginal-zone B-cell lymphoma (64%), follicle center lymphoma (10%), diffuse large cell B-cell lymphoma (9%), plasmacytoma (6%), and lymphoplasmocytic lymphoma (5%). Age, gender, and anatomic localization of the lymphomas did not have prognostic significance during a follow-up period of 6 months to 16.5 years (mean, 3.3 years). Extent of disease at time of presentation was the most important clinical prognostic factor: advanced disease correlated with increased risk ratios of having persistent disease at the final follow-up and with lymphoma-related death (P < 0.001). Histomorphologic features and immunohistochemical markers positively correlating with disseminated disease at presentation, stage at final follow-up, and occurrence of lymphoma-related death included cytologic atypia (P < 0.001), MIB-1 proliferation rate (P < 0.001), and tumor cell p53 positivity (P < 0.001). The MIB-1 proliferation rates greater than 20% in extranodal marginal-zone B-cell lymphoma corresponded to at least stage II lymphoma (P < 0.05). CONCLUSION The REAL classification is suitable for the subdivision of the ocular adnexal lymphomas. The MIB-1 proliferation rate and p53 positivity may aid the prediction of disease stage and disease progression, whereas PCR can support the diagnosis and reduce the number of histologically indeterminate lesions.
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Affiliation(s)
- S E Coupland
- Department of Pathology, Universitätsklinikum Benjamin Franklin, Freie Universität, Berlin, Germany
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Abstract
A retrospective histopathologic review of 97 patients with basal cell carcinoma of the eyelid was performed to determine the prevalence and behavior of tumors with a mixed pattern of growth. A mixed type basal cell carcinoma was defined as a tumor having a significant nodular or ulcerative component combined with an infiltrative component. Histologic classification of the 97 tumors yielded four (4.1%) that were multicentric, 67 (69.1%) that were nodular, one (1%) that was ulcerative, 13 (13.4%) that were infiltrative, and 12 (12.4%) that were the mixed variant. Follow-up was obtained on 8 of the 12 patients with mixed basal cell carcinoma. Three tumors recurred, but there were no tumor-related deaths. One of these patients underwent numerous eyelid resections over a 2-year period and then underwent an orbital exenteration. The authors conclude that mixed type basal cell carcinomas are not infrequent and behave as aggressively as basal cell carcinomas of the morphea type. A greater awareness and recognition of mixed type basal cell carcinomas by ophthalmologists and pathologists should result in fewer recurrences and better patient management.
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Affiliation(s)
- P K Bonner
- Department of Ophthalmic Pathology, Armed Forces Institute of Pathology, Washington, DC 20306-6000, USA
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20
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Ni Z. [Histopathological classification of 3,510 cases with eyelid tumor]. Zhonghua Yan Ke Za Zhi 1996; 32:435-7. [PMID: 9590811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To study the histopathological classification of eyelid tumor. METHOD The pathological specimens of 3,510 cases with eyelid tumor examined between 1953-1992 were retrospectively analyzed. RESULTS The 5 leading malignant lid tumors were basal cell carcinomas (430 cases, 37.6%), meibomian gland carcinomas (363, 31.7%), squamous cell carcinomas (216 cases, 18.9%), melanomas (56 cases, 4.9%) and malignant lymphomas (21 cases, 1.8%). The 5 leading benign lid tumors including papillomas (658 cases, 27.9%), pigmented nevi (578 cases, 24.4%), cysts (427 cases, 18.1%), angiomas (222 cases, 9.4% including 10 lymphangiomas) and verrucae (212 cases, 9.0%). Rare tumors of the eyelid included one case of each of the following tumors: reticulum cell sarcoma, adenocystic carcinoma, malignant mesenchymoma, mucinous adenocarcinoma, Bowen's disease, basosquamous carcinoma, basosebacious carcinoma, teratoma, granular cell tumor (myoblastoma), angiolymphoid hyperplasia with eosinophilia, osteoma, etc. CONCLUSION The classification and differentiation in type of eyelid tumor are beneficial to the histopathological diagnosis.
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Affiliation(s)
- Z Ni
- Department of Ophthalmology, Eye and Ear Nose Throat Hospital, Shanghai Medical University
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Abstract
Sebaceous carcinoma is a rare, aggressive, malignant tumor derived from the adnexal epithelium of sebaceous glands. It may arise in ocular or extraocular sites and exhibits such a variety of histologic growth patterns and diverse clinical presentations that the diagnosis is often delayed for months to years. We discuss incidence as well as clinical, histologic, diagnostic, prognostic, and management issues of this aggressive neoplasm.
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Affiliation(s)
- B R Nelson
- Department of Dermatology, University of Michigan, Ann Arbor, USA
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22
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Belevskiĭ AG, Kolotov VV. [Clinical forms and bases for treating vascular tumors of the eye adnexa in children]. Oftalmol Zh 1982; 37:77-79. [PMID: 7121970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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23
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Abstract
We studied the clinical and histopathologic features of 165 basal cell carcinomas of the eyelids and classified the tumors into four types (nodular, ulcerative, morphea, and multicentric) that differ in incidence, results of incomplete excision, aggressiveness, and recurrence. The value of frozen-section monitoring of the surgical margins was evident. In 39 cases excised with monitoring of the surgical margins by frozen sections, there were no recurrences. In 126 cases treated by excisional biopsy without frozen-section monitoring, 34 (26.9%) were incompletely excised and seven (5.5%) recurred. The surgical treatment of basal cell carcinoma should always include the use of frozen-section monitoring of the surgical margins. This is especially important in the morphea, multicentric, and ulcerative types, in which the invasive extent of the tumor is often not apparent clinically. These forms are also more aggressive.
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Abstract
The results of liquid nitrogen spray technique for 310 biopsy-proven eyelid malignancies are reviewed. The raw recurrence rate for basal cell carcinomas of the eyelids with a mean follow-up of almost three years is 4.2%, while the recurrence rate is 6% in 49 cases followed for five years. For all lid malignancies 10 mm or less in diameter, a 2.0% raw recurrence rate was obtained; however, in those lesions larger than 10 mm, this rose to 9.5%. With this form of therapy, basal cell carcinomas with infiltrative, nonelevated, indistinct borders had twice the recurrence rate than those tumors with elevated distinct borders. Twenty-one squamous cell carcinomas treated with cryosurgery with an average follow-up 21.6 months have yet to show a recurrence. Complications with cryosurgery include permanent loss of eyelashes and depigmentation lasting from six months to over six years. Depending on the extent and location of the tumor, eyelid defects occurred. To date, five plastic reconstructive procedures have been required for ectropion or lid defects; however, no lacrimal outflow surgery has as yet been required.
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Ni C, Guo BK. Pathologic classification of meibomian gland carcinomas of eyelids: clinical and pathologic study of 156 cases. Chin Med J (Engl) 1979; 92:671-6. [PMID: 116808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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Dhermy P. [Current classification of orbito-palpebral lymphoid tumors]. Bull Soc Ophtalmol Fr 1978; 78:847-50. [PMID: 582807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Segal N, Georgescu A, Mihailov C. [Classification and treatment of malignant eyelid tumors]. Rev Chir Oncol Radiol O R L Oftalmol Stomatol Ser Oftalmol 1978; 22:187-9. [PMID: 725149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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28
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Ziangirova GG, Brovkina AF. [Classification of eye neoplasms]. Vestn Oftalmol 1974; 2:84-7. [PMID: 4831578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Kircher CH, Garner FM, Robinson FR. Tumours of the eye and adnexa. Bull World Health Organ 1974; 50:135-42. [PMID: 4547651 PMCID: PMC2481216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Most types of epithelial tumour of the eyelids, conjunctiva, and cornea occur in all species; the most common type occurring in any species is bovine squamous cell carcinoma. Iridociliary epithelial tumours and malignant melanomas are the most important intraocular tumours. The histological features of the tumours are described under the following main headings: epithelial tumours of the eyelids, conjunctiva, and cornea; mesenchymal tumours (extraocular, optic nerve and nerve sheath, and uveal tract); neuroectodermal tumours; and melanogenic tumours of the eyelids and conjunctiva and of the uveal tract.
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