In recent years new modern therapeutic concepts have been developed in the treatment of malignant eyelid tumors; however, surgical restoration remains an important component of the therapeutic options addressed, which include microsurgical tumor excision into healthy tissue and subsequent coverage of the defects. An ophthalmic surgeon experienced in oculoplastic surgery is responsible for the recognition and evaluation of the existing alterations and planning a procedure together with the patient that meets the patient's expectations. The planning of surgery must always be individualized and fit the initial findings. Depending on the defect size and localization, different coverage strategies are available to the surgeon. To ensure successful reconstruction, every surgeon should master a wide range of reconstructive techniques.
In den letzten Jahren haben sich neue, moderne Therapiekonzepte in der Behandlung von malignen Lidtumoren entwickelt. Die chirurgische Sanierung bleibt jedoch weiterhin ein wichtiger Bestandteil der Therapiemöglichkeiten, welche die mikrochirurgische Tumorexzision im gesunden Gewebe sowie die anschließende Deckung der Defekte umfassen. Ein okuloplastisch erfahrener Ophthalmochirurg ist für die Erkennung und Bewertung der vorhandenen Veränderung zuständig und sollte zusammen mit dem Patienten ein dessen Vorstellungen entsprechendes Vorgehen planen. Die Operationsplanung muss stets individuell erfolgen und passend zum Ausgangsbefund durchgeführt werden. Abhängig von der Defektgröße und Lokalisation stehen dem Operateur unterschiedliche Deckungsstrategien zur Verfügung. Um eine erfolgreiche Rekonstruktion zu gewährleisten, sollte jeder Operateur eine breite Palette rekonstruktiver Techniken beherrschen.
- Klíčová slova
- Defect coverage, Microsurgical tumor excision, Oculoplasty, Ophthalmic surgeon, Reconstructive techniques,
- MeSH
- chirurgové * MeSH
- lidé MeSH
- nádory kůže * chirurgie MeSH
- nádory očního víčka * chirurgie MeSH
- oftalmologie * MeSH
- zákroky plastické chirurgie * MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
BACKGROUND/OBJECTIVES: To determine the incidence, proportion and location of periocular tumours in an English county over a five year period, and compare to other studies in the UK and worldwide. SUBJECTS/METHODS: A retrospective review of histopathology reports was performed for all periocular excision biopsies of malignancies from the county's three main hospitals over a 5-year period. These hospitals cover a population of just over one million. Tumours were classified according to type and location. RESULTS: 1220 lesions were included in this study. Right-sided lesions were more common than left. The incidence of basal cell carcinoma was 22 per 100,000 and squamous cell carcinoma 1.3 per 100,000, which were found most commonly on the lower eyelid and eyebrow respectively. The incidences of all other types of lesions were less than 0.5 per 100,000 per year. CONCLUSIONS: The incidence of periocular basal cell carcinomas in the predominantly elderly Caucasian population was at least three times the published national average. The high incidence of periocular tumours in this North East Anglian county is set to increase further as the proportion of over 65 year olds in the population is predicted to nearly double within two decades.
- MeSH
- bazocelulární karcinom * patologie MeSH
- lidé MeSH
- nádory kůže * patologie MeSH
- nádory očního víčka * patologie MeSH
- oční víčka chirurgie MeSH
- retrospektivní studie MeSH
- senioři MeSH
- spinocelulární karcinom * patologie MeSH
- Check Tag
- lidé MeSH
- senioři MeSH
- Publikační typ
- časopisecké články MeSH
- komentáře MeSH
- multicentrická studie MeSH
In recent years new modern therapeutic concepts have been developed in the treatment of malignant eyelid tumors; however, surgical restoration remains an important component of the therapeutic options addressed, which include microsurgical tumor excision into healthy tissue and subsequent coverage of the defects. An ophthalmic surgeon experienced in oculoplastic surgery is responsible for the recognition and evaluation of the existing alterations and planning a procedure together with the patient that meets the patient's expectations. The planning of surgery must always be individualized and fit the initial findings. Depending on the defect size and localization, different coverage strategies are available to the surgeon. To ensure successful reconstruction, every surgeon should master a wide range of reconstructive techniques.
In den letzten Jahren haben sich neue, moderne Therapiekonzepte in der Behandlung von malignen Lidtumoren entwickelt. Die chirurgische Sanierung bleibt jedoch weiterhin ein wichtiger Bestandteil der Therapiemöglichkeiten, welche die mikrochirurgische Tumorexzision im gesunden Gewebe sowie die anschließende Deckung der Defekte umfassen. Ein okuloplastisch erfahrener Ophthalmochirurg ist für die Erkennung und Bewertung der vorhandenen Veränderung zuständig und sollte zusammen mit dem Patienten ein dessen Vorstellungen entsprechendes Vorgehen planen. Die Operationsplanung muss stets individuell erfolgen und passend zum Ausgangsbefund durchgeführt werden. Abhängig von der Defektgröße und Lokalisation stehen dem Operateur unterschiedliche Deckungsstrategien zur Verfügung. Um eine erfolgreiche Rekonstruktion zu gewährleisten, sollte jeder Operateur eine breite Palette rekonstruktiver Techniken beherrschen.
- Klíčová slova
- Defect coverage, Microsurgical tumor excision, Oculoplasty, Ophthalmic surgeon, Reconstructive techniques,
- MeSH
- chirurgové * MeSH
- lidé MeSH
- nádory kůže * chirurgie MeSH
- nádory očního víčka * patologie MeSH
- oftalmologie * MeSH
- zákroky plastické chirurgie * MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
- přehledy MeSH
This article aims to present the differential diagnostics of benign and malignant eyelid tumours. The most common malignant eyelid tumour is basal cell carcinoma, followed by squamous cell carcinoma. The common signs of malignity are loss of lashes, ulceration, and infiltration of the lesion. Often the clinical appearance is various and therefore only a histological analysis gives the proper diagnosis. For most tumours, surgical resection is the gold standard of therapy. The reconstruction of the defects should be performed by an experienced oculoplastic surgeon. In malignant tumours that require large safety margins, the defect can be easily very large, and the reconstruction must then be performed with advanced ophthalmic plastic reconstruction techniques.
Dieser Artikel zielt darauf ab, die Differenzialdiagnostik von gutartigen und bösartigen Augenlidtumoren darzustellen. Der am häufigsten bösartige Augenlidtumor ist das Basalzellkarzinom, gefolgt vom Plattenepithelkarzinom. Die häufigsten Anzeichen von Malignität sind Verlust von Wimpern, Ulzeration und Infiltration der Läsion. Das klinische Erscheinungsbild ist vielfältig und daher nur ein histologisches. Die Analyse liefert die richtige Diagnose. Bei den meisten Tumoren ist die chirurgische Resektion der Goldstandard der Therapie. Die Rekonstruktion sollte von einem erfahrenen ophthalmoplastischen Chirurgen durchgeführt werden. Bei bösartigen Tumoren, die großen Sicherheitsabstand erfordern, kann der Defekt leicht sehr groß werden. Die Rekonstruktion muss dann mit fortgeschrittenen Techniken der plastischen Rekonstruktion durchgeführt werden.
Chronic eyelid edema may be a symptom of different disease. The most common are autoimmune diseases such as orbital pseudotumor, vasculitis, sarcoidosis, or impaired vascular or lymphatic drainage. Rarely has it been reported as the sole manifestation of the lymphoma. Eyelid lymphoma is a special clinical entity in the spectrum of hematological malignancies. Here we present our clinical experience with eyelids lymphomas. First case is a 76-year-old female patient with bilateral edema of upper eyelid non-responding to anti-inflammatory therapy. Histological examination diagnosed mantle cells lymphoma. In the second case, 58-year-old patient was diagnosed with solitary unilateral tumor of the lower eyelid, where primary biopsy was ordered and diagnosis of MALT lymphoma was established after histological examination. In both cases, it was not solitary eyelid tumor, but systemic disease with multiple lymphadenopathy and bone marrow infiltration were found in follow-up examinations. Subsequently, patients care was given to the hemato-oncologist.
- Klíčová slova
- B-lymphoma, eyelid edema, orbit,
- MeSH
- biopsie MeSH
- dospělí MeSH
- edém diagnóza etiologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- lymfom z B-buněk marginální zóny * komplikace diagnóza MeSH
- nádory očního víčka * komplikace diagnóza MeSH
- oční víčka MeSH
- senioři MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
The gold standard for the treatment of periocular basal cell carcinoma is surgical resection followed by ophthalmoplastic reconstruction. The highest priority in most cases is the complete histopathologically controlled tumor excision. The histopathological preparation can be carried out in two stages by rapid overnight embedding or intraoperatively by a rapid frozen section procedure. A variety of reconstruction methods enable a customized and in most cases also a cosmetically and functionally attractive defect coverage. Postoperatively, a regularly performed tumor aftercare is essential.
- Klíčová slova
- Defect coverage, Frozen sections, Histopathology, Reconstruction methods, Tumor excision,
- MeSH
- bazocelulární karcinom * MeSH
- lidé MeSH
- nádory kůže * MeSH
- nádory očního víčka MeSH
- retrospektivní studie MeSH
- zmrazené řezy MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
AIM: To get acquainted with the issues of Merkel cell carcinoma (MCC) when the eyelid is affected and with its surgical solution. MATERIALS: MCC of the right upper eyelid was at the Department of Ophthalmology in the Faculty Hospital Královské Vinohrady in Prague (Czech Republic, EU) in 1998 woman 78 year. Another cases of the MCC on the left upper eyelid were observed in two women aged 48 and 67 years and they were pick up in a retrospective study covered 1033 operated tumors eyelids years 2007 - 2015. 47,5% of operated tumors were benign and 52,5% malignant. Most common malignant processes were basal cell carcinoma in 77,3% and squamous cell carcinoma at 15,7%. RESULTS: The oldest patient died after three years of cardiopulmonary failure. 48 year old patient (age of diagnosis MCC) has been monitoring for five years without proven recurrence or metastasis dissemination. Oncological initial staging was negative regarding. An ultrasound examination of the lymphatic system of the neck was followed every six months. Another 67 year old patient (age of diagnosis MCC) was followed for 2,5 years. There was a suspicion of a metastatic process in the same side salivary gland and lungs, therefore chemotherapy was performed. Definitely, this process has not been proven. Now there is continuing follow up without sings of local recurrence or metastatic dissemination. CONCLUSION: The authors confirmed a rare occurrence of MCC, and only 0,37% among malignant eyelids tumors. Essential importance for successful treatment is a sufficiently radical excision supported by histological verification and a subsequent plastic surgery of the eyelid is also necessary. Key words: Merkel cell carcinoma, tumor of eyelid, ultrasound examination of nodes.
- Klíčová slova
- Merkel cell carcinoma, tumor of eyelid, ultrasound examination of nodes,
- MeSH
- lidé středního věku MeSH
- lidé MeSH
- lokální recidiva nádoru MeSH
- Merkelův nádor * diagnóza chirurgie MeSH
- nádory očního víčka * diagnóza chirurgie MeSH
- předškolní dítě MeSH
- retrospektivní studie MeSH
- senioři MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- předškolní dítě MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Česká republika MeSH
The incidence of Merkel cell carcinoma has tended to increase worldwide in recent years. Merkel cell carcinoma is a rare tumor of the skin that occurs mainly in the sun exposed sites. The malignant reversal of Merkel cells is currently associated with an infection caused by a Merkel cell polyomavirals. In some cases, the disease may have a relatively inconspicuous clinical picture in the initial phase, which is in contrast to its extensive microscopic propagation. For this reason, the risk of late diagnosis or insufficient primary surgery is increased. The diagnostic standard is histological and, in particular, immunohistochemical examination of tumor tissue samples. Merkel cell carcinoma is a marked tendency to local recurrence and early development of metastases in regional lymph nodes, followed by generalization. The basis of treatment is radical excision of the tumor by in most cases by adjuvant radiotherapy targeted at primary place of occurrence and the area of regional draining lymph nodes. The effectiveness of different chemotherapeutic protocols in Merkel cell carcinoma is mostly low and the median survival is low. From a prognostic point of view, Merkel cell carcinoma plays the most important role of staging the tumor at the time of capture. The suspected lesions in the area around the eye, eyelid and orbit need to indicate adequate therapeutic approach that the detection of the disease at the earliest stage. The authors describe the clinical experience in 2 patients with Merkel cell carcinoma of the eyelid and orbit. Key words: eyelid tumors, tumors of the orbit, Merkel cell carcinoma.
- Klíčová slova
- Merkel cell carcinoma, eyelid tumors, tumors of the orbit,
- MeSH
- lidé MeSH
- lokální recidiva nádoru MeSH
- Merkelův nádor * diagnóza terapie MeSH
- nádory kůže * diagnóza terapie MeSH
- nádory očního víčka * diagnóza terapie MeSH
- orbita MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
AIM: In the contemporary medicine, strong emphasis is put on early closing of body surface defects, which contributes to good and early healing, but, of course, closes the entrance gate for possible infection as well. The easiest closing of the defect is the direct suture of the emerged wound. But some defects are of such an extent, so their closure is necessary to handle other way than simple suture, e.g. by rotating flap plastic surgery. In the paper are evaluated results of flap surgery technique in 56 patients. MATERIAL AND METHODS: It is a retrospective overview of 56 patients operated on by the author in the years 2011-2012, in whom the rotating flap plastic surgery was used as surgery technique. In 46 patients, the reason of flap plastic surgery technique was tumor of the eyelids. In 35 patients, it was due to the basalioma of the lower eyelid, in 8 patients due to the basalioma of the upper eyelid, and in three patients due to the basalioma of the medial cantus region. In 10 patients, the reason of the surgery was ectropion of the lower eyelid, and in two of them bilaterally. The paper is supplemented by surgical procedures photographs, and by a table, with detailed analysis of the sizes of tumors and corresponding flaps as well. RESULTS: According to the experience with 56 rotating flap plastic surgeries, performed by author during the period of two years at the Department of Ophthalmology, Masaryk Hospital in Ústí nad Labem, Czech Republic. E.U., the results of the use of rotating skin flaps in 46 eyelids basalioma, of correcting 12 ectropions of the lower eyelid, and reliability of the tumors excision with 2 mm surrounding healthy tissue rim were followed-up. Using the mentioned surgery technique, it was possible in all patients to secure the closing of the eyelid defect, or to return to normal and correct anatomical position of the eyelids in ectropions. In two patients with basalioma of the lower eyelid, the additional technique of lateral cantotomy was used to relieve the tension in the wound. Statistical results of recurrences number in tumors excisions with 2 mm safety margin in to the healthy tissue confirm the relative safety of such wide excision, and our results (4.34 %) differ only slightly from the results published in the literature (4.0 %). KEY WORDS: flap plastic surgery, basalioma, ectropion.
- MeSH
- bazocelulární karcinom chirurgie MeSH
- blefaroplastika metody MeSH
- chirurgické laloky * MeSH
- ektropion chirurgie MeSH
- lidé středního věku MeSH
- lidé MeSH
- nádory očního víčka chirurgie MeSH
- oční víčka chirurgie MeSH
- reprodukovatelnost výsledků MeSH
- retrospektivní studie MeSH
- senioři MeSH
- zákroky plastické chirurgie metody MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
The reconstruction of complex craniofacial and orbital defects should satisfactorily restore functional and aesthetic integrity. Autologous reconstruction of nasal, periorbital and auricular facial subunits as a whole using a locoregional or a free flap is very challenging and the results are not sometimes ideal. With advanced technologies that are currently available it is possible to plan and produce authentic facial prosthesis that can satisfactory substitute these facial subunits. We demonstrate an alternative reconstructive concept for complex craniofacial defects based on a free flap combined with a facial prosthesis for the replacement of periorbital or auricular facial subunits. This approach was used in two patients with very satisfactory results. Combination of a free flap with a facial prosthesis may become a preferable approach for the reconstruction of complex craniofacial defects. Clinical outcomes of the reconstructions may be enhanced respecting the principle of aesthetic facial subunits.
- Klíčová slova
- Free flap, combination, craniofacial, epithesis, orbital auricular., reconstruction,
- MeSH
- bazocelulární karcinom chirurgie MeSH
- enukleace oka MeSH
- lidé středního věku MeSH
- lidé MeSH
- nádory kůže chirurgie MeSH
- nádory obličeje chirurgie MeSH
- nádory očního víčka chirurgie MeSH
- oční protézy * MeSH
- orbitální implantáty * MeSH
- protézy a implantáty * MeSH
- volné tkáňové laloky * MeSH
- zevní ucho chirurgie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
