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Type: Journal article
Title: Globe-sparing surgery for medial canthal basal cell carcinoma with anterior orbital invasion
Author: Madge, S.
Khine, A.
Thaller, V.
Davis, G.
Malhotra, R.
McNab, A.
O'Donnell, B.
Selva-Nayagam, D.
Citation: Ophthalmology, 2010; 117(11):2222-2228
Publisher: Elsevier Science Inc
Issue Date: 2010
ISSN: 0161-6420
Statement of
Simon N. Madge, Aye Aye Khine, Vladimir T. Thaller, Garry Davis, Raman Malhotra, Alan McNab, Brett O'Donnell and Dinesh Selva
Abstract: <h4>Purpose</h4>To describe a case series of patients with anterior orbital invasion by medial canthal basal cell carcinoma (BCC) managed with non-exenterating surgery.<h4>Design</h4>International, multicenter, retrospective, noncomparative, consecutive case series.<h4>Participants</h4>Twenty patients identified from the individual institutions' databases with histologically confirmed orbital invasion by periocular BCC.<h4>Methods</h4>Examination of charts, relevant imaging, and histopathologic data.<h4>Main outcome measures</h4>Demographics; clinical characteristics and radiologic features; histopathologic features; surgical techniques for excision, reconstruction, and subsequent procedures; complications; visual acuity; and recurrence.<h4>Results</h4>Twenty patients were identified. Twelve of 20 patients (60%) had recurrent BCCs, with 1 patient having had prior radiotherapy for previously incomplete excision. Eighteen of 20 patients (90%) had a palpable mass, 16 of 20 patients (80%) had clinical involvement of the nasolacrimal system, and 1 of 20 patients (5%) had limited extraocular movements. Preoperative radiologic evidence of orbital invasion was found in 10 of 20 patients (50%). Histologic evidence of orbital invasion was present in every patient, the subtypes being infiltrative (9/20, 45%), nodular (4/20, 20%), micronodular (2/20, 10%), multifocal (1/20, 5%), and mixed (4/20, 20%); extratumoral perineural invasion was present in 1 patient (5%). Final margins were clear in 18 of 20 patients (90%), positive in 1 of 20 patients (5%), and unclear in 1 of 20 patients (5%). Reconstruction was by direct closure in 1 patient and by a variety of standard oculoplastic flaps and grafts in 19 of 20 patients (95%). Twelve of 20 patients (60%) had postoperative extraocular muscle movement restriction, and 15 of 20 patients (75%) had epiphora. Subsequent revision procedures were needed in 12 of 20 patients (60%), including insertion of a lacrimal bypass tube and revision of medial canthal position. At a mean follow-up of 38 months, 18 of 20 patients (90%) were still alive (2 deaths due to other causes) with 1 recurrence (exenterated). Postoperative visual acuity was within 2 Snellen lines of preoperative visual acuity in 17 of 20 patients (85%).<h4>Conclusions</h4>With careful planning and margin control, conservative surgery in this highly selected group proved possible with a low rate of disease recurrence, albeit with a relatively short follow-up. Postoperative complications, such as epiphora and ophthalmoplegia, were largely expected; most patients underwent subsequent revision procedures to address these and other complications.<h4>Financial disclosure(s)</h4>The author(s) have no proprietary or commercial interest in any materials discussed in this article.
Keywords: Orbit
Carcinoma, Basal Cell
Orbital Neoplasms
Eyelid Neoplasms
Skin Neoplasms
Neoplasm Invasiveness
Neoplasm Recurrence, Local
Postoperative Complications
Tomography, X-Ray Computed
Treatment Outcome
Ophthalmologic Surgical Procedures
Retrospective Studies
Aged, 80 and over
Middle Aged
Rights: Copyright © 2010 American Academy of Ophthalmology. Published by Elsevier Inc.
DOI: 10.1016/j.ophtha.2010.02.013
Appears in Collections:Aurora harvest
Opthalmology & Visual Sciences publications

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