Periocular squamous cell carcinoma

University of Adelaide, Tarndarnya, South Australia, Australia
Clinical and Experimental Ophthalmology (Impact Factor: 2.35). 02/2007; 35(2):174 - 185. DOI: 10.1111/j.1442-9071.2006.01411.x


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.
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  • 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: Perineural invasion (PNI) by primary cutaneous cancers is an important adverse risk factor. Certain benign conditions may mimic microscopic PNI. Mohs surgery is being performed more frequently on smaller primary cutaneous malignancies. While PNI may be present in these cases, it is likely to be microscopic and asymptomatic, affecting as little as one cutaneous nerve branch. Review of the literature base regarding PNI as well as contribution of original findings. Four benign entities that could easily be confused with microscopic PNI are presented. At least four benign mimics of microscopic PNI exist, important in the differential diagnosis of microscopic PNI. Knowledge of these entities should help dermatopathologists to correctly distinguish them from PNI and avoid unnecessary additional treatment.
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