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Orbit (Amsterdam, Netherlands) Dec 2021The reconstruction of large (>50%) upper eyelid margin defects can be technically challenging, with multiple approaches described in the literature. We sought to review... (Review)
Review
PURPOSE
The reconstruction of large (>50%) upper eyelid margin defects can be technically challenging, with multiple approaches described in the literature. We sought to review the recent literature for new techniques or modifications to existing techniques.
METHODS
We conducted a Pubmed search for technique papers on the reconstruction of large upper eyelid defects published within the past ten years with a minimum of four patients.
RESULTS
We identified ten articles, and divided them into techniques that use a bridging flap from the lower eyelid and those that do not. The number of upper eyelids repaired in each article ranged from 4 to 17. Most techniques could be considered either a modification of the Cutler-Beard technique or a novel anterior lamella flap laid over a graft for the posterior lamella. Postoperative complications included upper or lower eyelid cicatricial retraction, trichiasis, entropion, and lagophthalmos.
CONCLUSIONS
Surgeons continue to innovate for this challenging reconstructive surgery. Overall, the trend was to use a graft, most commonly tarsoconjunctiva from the contralateral upper lid, to replace the posterior lamella, and a skin flap, from the lower eyelid or from the adjacent periorbital area, to replace the anterior lamella. Bridging techniques utilized the skin; the skin, orbicularis, and conjunctiva; or a tarsoconjunctival flap from the lower eyelid. Non-bridging techniques generally used a tarsoconjunctival or substitute graft for the posterior lamella, and a skin flap for the anterior lamella.
Topics: Entropion; Eyelid Diseases; Eyelid Neoplasms; Eyelids; Humans; Plastic Surgery Procedures; Skin Transplantation; Surgical Flaps
PubMed: 32990145
DOI: 10.1080/01676830.2020.1820045 -
Journal of Medicine and Life 2014Eyelids are very susceptible area for non-melanoma skin cancers; among that, basal cell carcinoma has the highest incidence (almost 90% of malignant eyelid tumors) and... (Review)
Review
RATIONALE
Eyelids are very susceptible area for non-melanoma skin cancers; among that, basal cell carcinoma has the highest incidence (almost 90% of malignant eyelid tumors) and 50-60% of eyelid basal cell carcinomas appear on inferior eyelid.
OBJECTIVE
To analyze clinical features of inferior eyelid basal cell carcinoma and to determine the efficacy of surgical treatment with frozen sectioncontrolled margins and methods of primary reconstruction of defects.
METHODS
A review of medical records of cases with primary inferior eyelid basal cell carcinoma treated by surgical excision with urgent histopathology controlled margins by FS technique, doubled by paraffin examination from October 2011 to October 2014. After histopathology confirmation of tumor free margins, proper inferior eyelid reconstruction was performed.
RESULTS
The review resulted in 36 patients with 36 lesions analyzed by clinical, histopatological and therapeuticalaspectswith a mean follow-up of 20 months. All lesions were primary BCC affecting inferior eyelid. There were no recurrence in the follow-up period. Inferior eyelid reconstruction techniques were direct closure for small defects and complex techniques for defects more than one third of eyelid length.
DISCUSSION
Appropriate eyelid examination is mandatory in any routine ophthalmic check-up. Clinical signs suggestive of BCC should be familiar to ophthalmologist in order to have an early diagnosis and treatment for these tumors. Surgical treatment with FS controlled excision followed by eyelid reconstruction is an efficient treatment for inferior eyelid BCC.
ABBREVIATIONS
basal cell carcinoma (BCC); frozen section (FS);Mohs micrographic surgery (MMS).
Topics: Aged; Aged, 80 and over; Carcinoma, Basal Cell; Demography; Eyelid Neoplasms; Female; Frozen Sections; Humans; Male; Middle Aged
PubMed: 27057245
DOI: No ID Found -
Ophthalmic Plastic and Reconstructive...It is generally believed that large eyelid defects must be repaired using a vascularized flap for 1 lamella, while the other can be a free graft. Recent studies indicate...
PURPOSE
It is generally believed that large eyelid defects must be repaired using a vascularized flap for 1 lamella, while the other can be a free graft. Recent studies indicate that the pedicle of a tarsoconjunctival flap does not contribute to blood perfusion. The purpose of this study was to explore whether large eyelid defects can be repaired using a free bilamellar eyelid autograft alone.
METHODS
Ten large upper and lower eyelid defects resulting from tumor excision were reconstructed using bilamellar grafts harvested from the contralateral or opposing eyelid. Revascularization of the flap was monitored during healing using laser speckle contrast imaging, and the surgical outcome was assessed.
RESULTS
The functional and cosmetic results were excellent. All grafts survived and there was no tissue necrosis. Only 1 patient underwent revision after 4 days as the sutures came loose. Two patients developed minimal ectropion but needed no reoperation. All patients were satisfied with the surgical results. Perfusion monitoring showed that the grafts were gradually revascularized, exhibiting 50% perfusion after 4 weeks and 90% perfusion after 8 weeks.
CONCLUSIONS
A free bilamellar eyelid graft appears to be an excellent alternative to the tarsoconjunctival flap procedure in the reconstruction of both upper and lower eyelid defects, especially in patients who cannot tolerate visual axis occlusion or the 2-stage procedure of the conventional staged flap procedure.
Topics: Blepharoplasty; Eyelid Neoplasms; Eyelids; Humans; Laser Speckle Contrast Imaging; Plastic Surgery Procedures; Retrospective Studies
PubMed: 32467523
DOI: 10.1097/IOP.0000000000001724 -
Eye (London, England) Dec 2023The COVID-19 pandemic created a requirement for reduced patient contact and reduced capacity in clinics. We previously published results of an Image-Based Eyelid Lesion...
INTRODUCTION
The COVID-19 pandemic created a requirement for reduced patient contact and reduced capacity in clinics. We previously published results of an Image-Based Eyelid Lesion Management Service (IBELMS) which was found non-inferior to traditional face-to-face clinic at diagnosing lesions and identifying eyelid malignancies. We now present first-year safety and efficacy data from this service.
METHODS
Data were collected retrospectively on all patients seen in NHS Greater Glasgow and Clyde eyelid photography clinics from 30 September 2020 to 29 September 2021, including referral source and diagnosis, time to clinic review, treatment and patient outcomes.
RESULTS
808 patients were included in the study. Chalazion was the most common diagnoses recorded (38.4%). There was a statistically significant decrease in mean time from referral to appointment time between the first 4 months and last 4 months of the service (93 days to 22 days, p ≤ 0.0001). 266 (33%) of patients were discharged following photographs, 45 (6%) were discharged for non-attendance and 371 (46%) were booked for a minor procedure. 13 biopsy-confirmed malignant lesions were identified; only 3 had been referred as suspected malignancy. 23 patients out of 330 with at least 6 months follow up (7%) were re-referred within 6 months of treatment or discharge; however, none of them with a missed periocular malignancy.
DISCUSSION
Eyelid photography clinics effectively reduce patient waiting times and maximise clinic capacity. They accurately identify eyelid lesions including malignancies with a low re-referral rate. We propose that an image-based service for eyelid lesions is a safe and effective way of managing such patients.
Topics: Humans; Retrospective Studies; Pandemics; Skin Neoplasms; Eyelid Neoplasms; Eyelids
PubMed: 37225825
DOI: 10.1038/s41433-023-02572-2 -
Asia-Pacific Journal of Ophthalmology... 2015Sebaceous carcinoma is a malignancy arising in the periocular region that can lead to blindness and tumor-related metastases. This study is a review of published... (Review)
Review
Sebaceous carcinoma is a malignancy arising in the periocular region that can lead to blindness and tumor-related metastases. This study is a review of published literature and personal experience. This malignancy can arise from the sebaceous units in the tarsus (meibomian glands), in association with the cilia (Zeis glands), in the brow, and in the caruncle. There is a tendency for diffuse intraepithelial growth (pagetoid spread) that can be clinically invisible. Detection before lymph node metastasis is critical. This malignancy often masquerades as chronic unilateral conjunctivitis or blepharitis, typically in older patients. Management includes a 2-step approach with step 1 focused on eyelid and conjunctival map biopsies to determine the full extent of solid deep tumor and pagetoid spread. After complete review of all biopsies, step 2 is performed using local resection for all deep tumor, cryotherapy to pagetoid disease, and reconstruction. In most cases, the posterior lamella of eyelid is sacrificed with tumor removal, whereas the anterior lamella of the eyelid can be saved. After removal and cryotherapy, immediate reconstruction, using clean instruments, with buccal membrane graft for the posterior lamella and skin flap for the anterior lamella, is developed. For persistent or recurrent pagetoid disease, cryotherapy, topical mitomycin C, or plaque radiotherapy is provided. Exenteration is sometimes necessary. Sebaceous carcinoma, if detected early, can be managed with carefully planned map biopsy to determine tumor extent, followed by local resection, cryotherapy, and eyelid reconstruction. Orbital exenteration is occasionally necessary.
Topics: Adenocarcinoma, Sebaceous; Antineoplastic Agents; Brachytherapy; Conjunctival Neoplasms; Cryosurgery; Cryotherapy; Diagnosis, Differential; Eyelid Neoplasms; Humans; Mitomycin; Neoplasm Recurrence, Local; Sebaceous Gland Neoplasms
PubMed: 26147013
DOI: 10.1097/APO.0000000000000105 -
Turkish Journal of Ophthalmology Sep 2019Solitary neurofibroma is a rare, benign tumor of the peripheral nerve sheath, and is often associated with neurofibromatosis type 1. Herein, a case of palpebral tarsal... (Review)
Review
Solitary neurofibroma is a rare, benign tumor of the peripheral nerve sheath, and is often associated with neurofibromatosis type 1. Herein, a case of palpebral tarsal solitary neurofibroma in a patient without neurofibromatosis is presented, with a review of the literature. A 68-year-old man presented with a subcutaneous mass in the right upper eyelid of 6 months’ duration. Eversion of the eyelid revealed a round, reddish mass on the lateral part of the tarsal plate which measured 12x8 mm in size. The lesion was excised with its tarsal base, diagnosed histologically, and did not recur during a follow-up of 34 months. Isolated, solitary neurofibroma of the eyelid has been reported in a total of 7 cases, including the case presented herein. The tumors arose from the eyelid margin in 4 cases, from the tarsal plate in 2 cases, and from the supratarsal conjunctiva in 1 case. The tumor did not recur after surgical excision in 5 cases for which follow-up data were available.
Topics: Aged; Eyelid Neoplasms; Humans; Male; Neurofibroma
PubMed: 31486611
DOI: 10.4274/tjo.galenos.2019.47124 -
BioMed Research International 2017Reconstruction of the eyelids after skin cancer excision can be challenging. Surgical treatment options are multiple; deep anatomy knowledge of lamellar components is... (Review)
Review
Reconstruction of the eyelids after skin cancer excision can be challenging. Surgical treatment options are multiple; deep anatomy knowledge of lamellar components is mandatory to choose the most adequate surgical planning. Eyelids' role in vision and social relationship is critical; both function and aesthetics are tough to restore. Using a flap provides a satisfying texture and colour match with adjacent tissues and ensures short contraction during healing; furthermore, grafts are sometimes necessary to achieve pleasing results. Hundreds of surgical techniques have been described aiming for eyelid reconstruction; in our paper, we want to provide for our audience the most reliable and useful procedures for subtotal and total eyelid reconstruction following NMSC full-thickness excision.
Topics: Eyelid Neoplasms; Eyelids; Humans; Plastic Surgery Procedures; Skin Neoplasms; Skin Transplantation; Surgical Flaps
PubMed: 29226145
DOI: 10.1155/2017/6742537 -
Middle East African Journal of... 2014Angiokeratoma is a rare, usually acquired muco-cutaneous wart-like vascular lesion that is frequently reported in the scrotum. Bleeding may occur if angiokeratoma is...
Angiokeratoma is a rare, usually acquired muco-cutaneous wart-like vascular lesion that is frequently reported in the scrotum. Bleeding may occur if angiokeratoma is excoriated or traumatized. We report an exceedingly rare solitary eyelid angiokeratoma in an otherwise normal middle aged male. Our case represents the second case in the English peer reviewed literature since 1966, when the first case of eyelid angiokeratoma was reported.
Topics: Angiokeratoma; Eyelid Neoplasms; Humans; Male; Skin Neoplasms
PubMed: 25100920
DOI: 10.4103/0974-9233.134702 -
The British Journal of Ophthalmology Aug 2022To assess epidemiological tumour features, risk factors, clinical management and outcome of eyelid squamous cell carcinoma (SCC) and changes thereof. Furthermore, we...
BACKGROUND/AIMS
To assess epidemiological tumour features, risk factors, clinical management and outcome of eyelid squamous cell carcinoma (SCC) and changes thereof. Furthermore, we searched for validating predictors of the American Joint Committee on Cancer (AJCC) 8 classification system.
METHODS
We evaluated data of 117 patients with histologically proven eyelid SCC at a large tertiary German university centre between January 2009 and March 2020. This retrospective, monocentric analysis included descriptive statistics and non-parametric tests (p<0.05).
RESULTS
Histologically controlled excision and follow-up was performed in 88 (75.2%) patients. In the remaining patients with higher T-category, individual adjuvant therapy combinations were initiated. We found higher numbers of nodal metastasis and recurrence for male patients and higher T-category (p=0.035, p=0.008 and p=0.001, p<0.001). Recurrence rates proved higher for patients with multiple lesions (p=0.008). Disease-specific survival (DSS) was 95.7% at 2 and 94.9% at 5 years of follow-up. Six patients (5.1%) died from eyelid SCC with nodal metastasis and higher T-category being negative prognostic factors (p<0.001 and p=0.009). Mortality was associated with tumour location in the medial upper eyelid, nodal metastasis being more frequent (p=0.001 and p=0.009) and tumour of the lower eyelid alone as positive predictor (p=0.012). T category differed in 34 (29.1%) patients when comparing AJCC 7 and 8 (p<0.001). Changes in T category as per the AJCC 8 classification resulted in better prediction of DSS (p=0.024).
CONCLUSION
Special attention should be paid to male patients, tumour location in the upper medial eyelid and lymph node diagnostics. Prediction of DSS proved superior as per the AJCC 8 staging system.
Topics: Carcinoma, Squamous Cell; Eyelid Neoplasms; Eyelids; Female; Humans; Lymphatic Metastasis; Male; Neoplasm Staging; Prognosis; Retrospective Studies; Transforming Growth Factor beta
PubMed: 33712477
DOI: 10.1136/bjophthalmol-2020-317969 -
The Pan African Medical Journal 2018
Topics: Aftercare; Aged; Eyelid Neoplasms; Eyelids; Humans; Sarcoma, Kaposi
PubMed: 30061960
DOI: 10.11604/pamj.2018.29.182.9651