Periocular squamous cell carcinoma
ABSTRACT 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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ABSTRACT: There are a multitude of diseases that commonly affect both the skin and the eye. Part II of this 2-part series reviews the oculocutaneous manifestations of neoplasms, both benign and malignant, and adverse drug reactions affecting the skin and the eye. Though rare, a number of neoplasms that primarily involve the skin, such as melanoma and basal cell carcinoma, can metastasize to the eye, leading to permanent damage if not properly treated. In addition, periocular neoplasms can irritate the conjunctiva and lid, reducing a patient's ability to see clearly. Neoplastic diseases, such as xeroderma pigmentosum, Sturge-Weber syndrome, and multiple myeloma, can also lead to permanent changes in the eye if not discovered and managed promptly. Furthermore, there are a multitude of drugs, including those commonly used by dermatologists, which can result in permanent damage to the eye. With proper knowledge of the ocular manifestations and treatment recommendations described in this 2-part series, dermatologists with the assistance of their ophthalmology colleagues can help avoid the complications, including permanent blindness, associated with infectious, inflammatory, genetic, neoplastic, and drug-related conditions.Journal of the American Academy of Dermatology 05/2014; 70(5):821.e1-821.e19. DOI:10.1016/j.jaad.2013.12.019 · 5.00 Impact Factor
Dataset: Ramkumar - XP, Surv Ophthal
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ABSTRACT: Recent observational studies have reported that perineural invasion (PNI) may be a negative prognostic factor in cervical cancer. The purpose of this meta-analysis is to systematically analyse the effect of PNI on overall survival and disease-free survival. The PubMed and Cochrane clinical trials databases were searched for articles with publication dates up to September 2013. Retrospective observational studies with survival analysis for perineural invasion after radical hysterectomy plus lymphadenectomy of cervical cancer were selected. Trial characteristics and outcomes and quality measures based on the Newcastle-Ottawa scale (NOS) were independently extracted. The overall survival and disease-free survival of patients with PNI were measured using a hazard ratio (HR) for time to event outcomes. The meta-analysis of these studies demonstrated that cervical cancer with PNI was associated with a lower overall survival rate (HR 2.21, 95 % CI 1.36-3.59, P = 0.001). Although the disease-free survival was lower in the PNI group (HR 1.35, 95 % CI 0.78-2.31, P = 0.28), the results were not statistically significant. Patients with PNI-positive cervical cancer have a poor overall survival rate; therefore, we can conclude that perineural invasion (PNI) is an adverse prognostic factor in cervical cancer. Based on these results, PNI should be an independent prognostic factor for cervical cancer and the decision to proceed with adjuvant therapy after surgery.Archives of Gynecology and Obstetrics 01/2015; DOI:10.1007/s00404-015-3627-z · 1.28 Impact Factor