Periocular squamous cell carcinoma
Squamous cell carcinoma (SCC) is the second most common eyelid malignancy and its incidence is increasing. Because of its variable clinical presentation, SCC may be difficult for even the experienced clinician to diagnose. Hence, all suspicious lesions warrant biopsy. As SCC behaviour may range widely in aggression, management should be individualized based on tumour (e.g. size, location, grade, histological subtype, previous recurrence, perineural invasion) and patient factors (e.g. age, health). Treatment of eyelid SCC should include margin control whenever possible for the highest cure rate in this high-risk area. Immediate histological monitoring of surgical margins with frozen sections or Mohs’ micrographic surgery also allows for smaller margins of excision in an area where tissue conservation is important. Other special considerations in the periocular area include maintaining a high level of suspicion for perineural invasion as this may be associated with a poorer prognosis.
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- "In periorbital malignancies, regional lymph node metastasis occurs through lymphatic pathways from the upper or lower eyelids. Depending on the site of the primary tumor, draining lymph nodes could be located in the parotid area or cervical region (1, 2). The rate of regional metastasis has been reported to be 10% to 24% in squamous cell carcinomas of the eyelid (3, 4) and 17% to 28% in sebaceous carcinomas (4, 5). "
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ABSTRACT: The aim of this study was to assess the clinical role of (18)F-FDG PET/CT for the evaluation of lymph node metastasis in periorbital malignancies, compared with CT alone.
We analyzed eighteen PET/CT and CT scans in 15 patients with biopsy-proven periorbital malignancies. We compared the diagnostic capabilities of PET/CT and CT with regard to nodal metastasis by level-by-level analysis and by N staging prediction. The reference standards were surgical pathology (n = 7) from dissected lymph node specimens and the results from radiological follow-up (n = 11, mean 20.5 months; range 10-52 months). Moreover, any changes in patient care as prompted by PET/CT were recorded and compared with treatment planning for CT alone.
PET/CT had a sensitivity of 100%, while CT had a sensitivity of 57% (p = 0.03) for nodal metastasis by level-by-level analysis. PET/CT had a specificity of 97%, positive predictive value of 93%, negative predictive value of 100%, and diagnostic accuracy of 98%, while the CT values for these same parameters were 97%, 89%, 82%, and 84%, respectively. PET/CT correctly predicted N staging with an accuracy of 100%, while CT was only 83% accurate (p = 0.01). Regarding the impact on patient care, the extent of surgery for regional lymph nodes and the treatment decision were modified by PET/CT in 39% of patients.
PET/CT could provide useful information in the management of regional lymph node metastases in patients with periorbital malignancies.
Korean Journal of Radiology 02/2009; 10(1):1-7. DOI:10.3348/kjr.2009.10.1.1 · 1.57 Impact Factor
Clinical and Experimental Ophthalmology 04/2007; 35(2):111-2. DOI:10.1111/j.1442-9071.2007.01474.x · 2.35 Impact Factor
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ABSTRACT: Eyelid malignant tumor has relatively high incidence with complex manifestations, easily leading to misdiagnose. Fine-needle aspiration biopsy (FNAB) should be recommended when indicated, consideiing its validity in determining the type of eyelid tumor pathologically and its contribution to guide surgical treatment. Surgery is the most preferred method in dealing with eyelid malignancy. However, no consensus with regard to surgical options and margins of exeresis has been reached so far. Mohs micrographic surgery(MMS), which is being increasingly advocated, is the most reliable method of assessing tumor margins by frozen section with both complete removal of tumor and extreme spare of eyelid tissue. Immediate repair of eyelid defect following tumor removal is a key step for which good understanding of oculoplastic techniques is needed. Reconstructive choices for eyelid depend on size, range and location of eydlid defect. Based on these, the curable effect as well as cosmetically satisfactory appearance can be achieved. Postoperative follow up is necessary and life-long follow up may even be considered to be routinely carried out in order to discern recurrence or metastasis upon onset of it.
Ophthalmology in China 11/2008; 17(6):361-363.
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