Orbital Invasion by Periocular Basal Cell Carcinoma

Leibovitch, Igal; McNab, Alan A.; Sullivan, Tim; Davis, Garry; Selva, Dinesh

doi:10.1016/j.ophtha.2004.11.036

Cited by 154 publications

(166 citation statements)

References 32 publications

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“…The incidence of orbital invasion is about 2-4%, [20][21][22] and the risk factors include multiple recurrences, large size, aggressive histological subtype, perineural spread, canthal locationFparticularly the medial canthusF, and older patients. [22][23][24][25] Exenteration for sebaceous gland carcinoma is more likely to be required if there is intraepithelial (pagetoid) spread of the tumour. 26 Perineural invasion occurs in less than 1% of basal cell carcinomas, 18,27 but in about 3-14% of squamous cell carcinomas.…”

Section: Indicationsmentioning

confidence: 99%

“…17,28 It is more common in lesions of the forehead and brow 29,30 and with aggressive cell types. 23,24,28,31 Clinical signs…”

Section: Indicationsmentioning

confidence: 99%

Section: Indicationsmentioning

confidence: 99%

“…23 As the disease progresses fixation to bone, limitation of ocular motility and globe displacement may occur. 22,23,29 Spread through the periorbita into bone has been reported in 20-30% of cases. 4,23 Perineural spread is also asymptomatic in the early stages, but eventually results in numbness or, less frequently, pain in the distribution of the trigeminal nerveFespecially the supraorbital nerve in periocular tumours.…”

Section: Indicationsmentioning

confidence: 99%

“…CT is more appropriate for bone destruction, MRI demonstrates the extent of soft tissue invasion and can sometimes detect the integrity of the periorbitaFthe most effective barrier to tumour spread. 22,23,32,33 …”

Section: Investigationmentioning

confidence: 99%

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Orbital exenteration for invasive skin tumours

Tyers

2006

Eye

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Orbital exenteration aims at local control of disease invading the orbit that is potentially fatal or relentlessly progressive. Of all exenterations presenting to ophthalmologists, 40-50% are required for tumours in the eyelid or periocular skin. 99% of these are basal cell carcinomas and 4-6% each are squamous cell carcinomas or sebaceous gland carcinomas. Orbital invasion results in progressive fixation of the tumour to bone and reduced ocular motility. Perineural invasion of branches of the trigeminal nerve leads to numbness or pain, and that the facial nerve, to weakness. Biopsy identifies the cell type and the presence of perineural invasion. CT and MRI scanning help in the assessment of tumour spread within the orbit. Management should be in collaboration with an oncologist. Exenteration may be totalthe removal of all orbital contents-or lidsparing if the tumour is placed posteriorly. The socket may be allowed to heal by granulation or lined with a split skin graft or local flap. Complications may be seen following 20-25% of exenterations and include fistulae, tissue necrosis, exposed bone, and infection. Incomplete clearance of tumours occurs in about 38% of total exenterations and 17% of subtotal. The overall 5-year survival is 55-65%, but significantly worse if there was perineural spread. Facial prostheses may be mounted on glasses or secured with tissue glue or osseointegrated implants. Excellent cosmetic results can be achieved but many patients prefer to wear a patch.

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Section: Indicationsmentioning

confidence: 99%

“…17,28 It is more common in lesions of the forehead and brow 29,30 and with aggressive cell types. 23,24,28,31 Clinical signs…”

Section: Indicationsmentioning

confidence: 99%

Section: Indicationsmentioning

confidence: 99%

Section: Indicationsmentioning

confidence: 99%

Section: Investigationmentioning

confidence: 99%

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Orbital exenteration for invasive skin tumours

Tyers

2006

Eye

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Vismodegib as Eye-Sparing Adjuvant Treatment for Orbital Basal Cell Carcinoma

2013

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If these lesions were at the level of the RPE, one would expect them to be visualized on FAF imaging. However, they were completely silent on FAF imaging, suggesting that they may be located deeper than the RPE, at the level of the choriocapillaris. We distinguished 3 types of lesions based on their multimodal imaging characteristics in APMPPE. Type 1 lesions seem to be located at the level of the choriocapillaris and are transient. Type 2 and 3 lesions are at the level of the RPE and are permanent.The pigmented lesions were distributed along the choroidal vasculature on AO imaging (Figure 2). They may correspond to pigment-laden macrophages or accumulation of pigment granules and may indicate a secondary reaction at the level of the RPE induced by an inflammatory process at the level of the choroidal vasculature. Their size and shape were not consistent with RPE cells.Acute posterior multifocal placoid pigment epitheliopathy is characterized by prominent RPE changes, but the permanent RPE damage (type 2 and 3 lesions) may be secondary to an acute transient choroidal inflammatory process (type 1 lesions).

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Neoplasms of the Eye and Orbit

Alvarez¹,

Ponce²,

Chevez‐Barrios³

et al. 2022

Holland‐Frei Cancer Medicine

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Overview Cancers of the eye and orbit are associated with diverse pathological conditions, disease prognosis, and significant mortality. The survival rates vary among patients from different countries and have been reported to be significantly lower in those from developing countries compared to those noted in the United States owing mainly to delay in diagnosis associated with advanced‐stage disease and unavailability of treatments. In this article, we provide an overview of the most common and rare ophthalmic malignancies that include ocular surface, external and adnexal diseases, and orbital and intraocular malignancies. We summarize the incidence, histopathology, risk factors, molecular alterations, clinical presentation, diagnostic evaluation, and therapeutic approaches for these diseases. We also describe the first‐line and salvage treatments and their complications. These treatments depend on disease stage at presentation and include pathology‐guided excision, Mohs microsurgery, chemo‐reduction, chemoprophylaxis, adjuvant chemotherapy after enucleation, and/or neoadjuvant chemotherapy. Complications include symblepharon, scarring, and limbal stem cell deficiency while incomplete excision of eyelid tumors may result in recurrence of larger and more aggressive tumors. Currently, identification of genetic abnormalities identified in genomic profiling of patient tumors improves treatment selection. Early diagnosis and involvement of an ocular oncologist at the time of diagnosis will optimize the therapeutic management of patients with these diseases.

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Orbital Invasion by Periocular Basal Cell Carcinoma

Cited by 154 publications

References 32 publications

Orbital exenteration for invasive skin tumours

Orbital exenteration for invasive skin tumours

Vismodegib as Eye-Sparing Adjuvant Treatment for Orbital Basal Cell Carcinoma

Neoplasms of the Eye and Orbit

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