Periocular malignancy.
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(Title page, contents and summary only)
Date
2014
Authors
Selva, Dinesh
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Thesis
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Abstract
The collected publications that constitute this thesis focus on the management of periocular malignancy. The most common tumours to involve the eyelids in order of frequency are: basal cell carcinoma (90%), squamous cell carcinoma (5-8%), sebaceous gland carcinoma (2-3%) and melanoma (1%). The eyelids represent a high risk area for recurrence and are also functionally integral to the protection of the eye. Hence, surgical excision in this crucial region is best peformed with intraoperative histological margin control to achieve optimal cure rates and maximise tissue conservation. Margin control which utilises an en-face examination of the margins generally results in higher cure rates than standard breadloaf sections. Mohs micrographic surgery is a frozen section technique that aims to examine 100% of the peripheral margin. The Australian Mohs database was a prospective, interventional, multicentre, nationwide study of over 13,000 subjects designed to assess the efficacy of Mohs micrographic surgery for non-melanoma skin cancer. The 5-year recurrence rates were 0% and 7.8% for primary and recurrent BCC of the eyelids respectively and 3.64% for primary periocular SCC. Meticulous preoperative staging is vital in planning treatment for all eyelid carcinomas. The American Joint Committee on Cancer TNM 7th edition staging system for eyelid carcinoma should be used to enable comparison of data in future research. lt may also allow better estimation of prognosis for individual patients and assist in identifying those who may benefit from interventions such as strict regional node surveillance or sentinel lymph node biopsy. Once surgical excision is performed, the primary goal of eyelid reconstruction is ocular protection. Due to the unique structure of the eyelid, reconstruction of significant defects must replace both the anterior and posterior lamellae with similar tissues. Reconstruction should be approached in a conceptual manner which considers the numerous options for both posterior and anterior lamellae and the variety of combinations which result. Treatment should be individualized to each patient with the lamellae being replaced with anatomically similar tissues when possible.
School/Discipline
School of Medicine
Dissertation Note
Thesis (M.D.) -- University of Adelaide, School of Medicine, 2014
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Description
Title page, table of contents and abstract only. The complete thesis in print form is available from the University of Adelaide Library.