Ocular Adnexal Reconstruction for Cutaneous Periocular Malignancies

Abstract

Although the majority of lesions present in the periocular region are benign, periocular cutaneous malignancies are certainly not uncommon and must be considered. The management of nonmelanoma cutaneous malignancies is predominately surgical with Mohs micrographic surgery or excision with frozen sections. The approach to reconstruction of the resulting defects depends on the defect location and size. When able, it is preferable to close lesions directly or with the recruitment of adjacent tissue in an effort to preserve the inherent anatomy. The eyelid's dynamic function is thus maintained, which is essential for optimal ocular surface protection. However, larger and more extensive defects will require complex reconstructions that are able to restore the necessary structural integrity to the eyelids. The authors review the various reconstruction approaches for defects of all sizes involving the periocular area including nonmarginal defects and defects of the lower and upper eyelids, as well as those of the medial canthal region.

Utility of the Glabellar Flap in the Reconstruction of Medial Canthal Tumors after Mohs Surgery

“…Tumors of the periorbital region present unique assessment, diagnostic, and therapeutic challenges. 1 , 3 The most prevalent malignant lesion in the eyelids is BCC (80-92.2%) 10 followed by squamous cell carcinoma, sebaceous gland carcinoma, and cutaneous melanoma. 1 BCC most frequently affects the lower lid and medial canthus or extends to involve both areas.…”

“… 1 In these disorders, the goal of the surgical treatment is to obtain a precise ablation of the entire carcinoma using an accurate histological control. 3 …”

“…Conservation of the normal tissue is especially important with eyelid tumor removal because of the limited amount of tissue available to achieve acceptable cosmetic results and preserve normal eyelid function. 13 As described by Huggins et al 3 , MMS is regarded as the gold standard for treatment of BCC with deep tissue invasion in the MCR. It has the benefit of sampling and examining small quadrants of anatomically localized tissue, allowing the surgeon to return to the positive tumor margin and remove tissue only in that small designated area.…”

“… 13 , 14 For primary BCC and squamous cell carcinoma, MMS has an overall 5-year cure rate of 97-99%. 3 …”

“…Mohs micrographic surgery (MMS) is a very useful technique since it ensures complete cancer removal and decreases the amount of healthy tissue that is excised. 3 In the medial canthal region (MCR), reconstructive methods are selected depending on the size and location of the defect and morbidity of the donor site. When deeper defects straddle, skin flaps are the best choice.…”