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.
PURPOSE OF REVIEW: Due to the limited number of cases, there are no guidelines for basal cell carcinoma (BCC) of the prostate. This review combines an unpublished case report of a 55-year-old patient with BCC with an assessment of the latest literature. RECENT FINDINGS: BCC of the prostate has previously been described in only approximately 140 cases. We describe the diagnostic process, including the uropathological and DNA-sequencing results, which allowed us to start an experimental treatment with pemigatinib. BCC of the prostate is associated with an aggressive biological and clinical behavior, such as recurrence and metastasis. Several immunohistochemical stainings are available to differentiate BCC from adenocarcinoma of the prostate. Based on pathology and results from next-generation sequencing (NGS), patients can be offered targeted therapies. SUMMARY: With the aid of histological work-up and immunostaining, prostatic BCC can be accurately diagnosed. Our patient underwent radical prostatectomy and staged extended lymphadenectomy due to lymph node recurrence. The patient subsequently developed progressive disease and was treated with the FGFR-inhibitor pemigatinib. The patient's liver metastasis significantly responded. The present case confirms the possibility of aggressive behavior of prostatic BCC and highlights the importance of a thorough uropathological and molecular biological analysis with a precision medicine strategy.
- MeSH
- bazocelulární karcinom * diagnóza patologie chirurgie MeSH
- lidé středního věku MeSH
- lidé MeSH
- lymfadenektomie MeSH
- morfoliny MeSH
- nádory kůže * chirurgie MeSH
- nádory prostaty * diagnóza farmakoterapie genetika MeSH
- prostata patologie MeSH
- prostatektomie MeSH
- pyrimidiny MeSH
- pyrroly MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
- přehledy MeSH
- Názvy látek
- morfoliny MeSH
- pemigatinib MeSH Prohlížeč
- pyrimidiny MeSH
- pyrroly MeSH
AIM: We present the management of a severe case of recurrent periocular basal cell carcinoma, orbital invasion and exenteration. CASE REPORT: The present case is of a recurrent basal cell carcinoma in a 84-year-old male presenting with non-healing lesion above right eyelid. A tumor excision was performed in May 2014. Histopathology revealed a basal cell carcinoma (dg. C44.1 ICD-10-CM) with positive margins. The re-excision of the lesion was performed. After two years, there was a local recurrence and orbital invasion. Indication for external curative radiation therapy. Plastic surgery of the upper eyelid. Orbital exenteration was indicated in January 2018. After another year, a recurrence of the tumor was once again noted. Histopathology revealed a basal cell carcinoma (dg. C44.1 (TNM 7, pMx, pNx, pTx)). The patient was indicated for external radiotherapy. There were no indications for biological treatment. After another year, a progression of the local finding was noted. CONCLUSION: Basal cell carcinoma (BCC) is the most common non-melanoma skin cancer of the periocular region. Primary treatment of basal cell carcinoma is surgical. Advanced lesions require extensive surgical interventions and other available treatment modalities. In some cases, mutilating surgery - exenteration of the orbit is inevitable. Despite a relatively small percentage of invasive diseases today, advanced stages may still occur; either as a result of the patient's late presentation, inadequate initial therapy aimed at maintaining critical periorbital structures, or due to high tumor aggression. The case report highlights necessity of radical resection of primary tumor with histological examination.
- Klíčová slova
- basal cell carcinoma, orbital exenteration, periocular tumors, tumors eyelashes,
- MeSH
- bazocelulární karcinom * diagnóza chirurgie MeSH
- eviscerace orbity MeSH
- lidé MeSH
- lokální recidiva nádoru MeSH
- nádory kůže * diagnóza chirurgie MeSH
- oční víčka MeSH
- senioři nad 80 let MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
Basal cell carcinoma (BCC) is the most prevalent malignancy, with rising incidence worldwide. Despite its naturally slow growth and initially low metastatic potential, it can cause significant morbidity and mortality when unrecognized, inadequately treated or poorly followed up. Authors present the case of a 61-year-old male with a 7-year history of multiple incomplete excisions of a “simple” BCC on the forehead. A CT scan of the head revealed an invasive mass (5.2 cm laterolateral x 4.0 cm craniocaudal) in the frontal area. There was no evidence of metastasis. Complete resection of the lesion and reconstruction was achieved in three stages. Final reconstruction was achieved using a left frontal fasciocutaneous flap. The secondary defect was closed with an advancement flap of the scalp and donor sites were covered using a split-thickness skin graft from the upper limb. This case demonstrates the necessity for vigilance in the approach to, diagnosis, treatment and follow-up of these skin neoplasms. The development of giant BCCs should be avoided at all costs. Increased size of BCCs corresponds with increased recurrence rate, metastatic rate, morbidity, mortality, treatment difficulties and overall costs.
- Klíčová slova
- Basal cell carcinoma, giant basal cell carcinoma, local invasion, plastic surgery, reconstructive surgery, recurrence,
- MeSH
- bazocelulární karcinom diagnostické zobrazování prevence a kontrola chirurgie MeSH
- čelo MeSH
- chirurgické laloky MeSH
- lidé středního věku MeSH
- lidé MeSH
- lokální recidiva nádoru MeSH
- nádory kůže diagnostické zobrazování prevence a kontrola chirurgie MeSH
- nádory obličeje diagnostické zobrazování prevence a kontrola chirurgie MeSH
- počítačová rentgenová tomografie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky 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
AIM: Non-melanoma skin cancer cases in the European population are increasing. Basal cell carcinoma (BCC) is the most common non-melanoma skin cancer of the eyelids and in the inner corner of the eyelid. Due to the latest statistics compiled and published in 2008 in the Slovak Republic (SR) there were registered 5,173 cases of non-melanoma skin cancer (C44 according to ICD-10) in both sexes together (of which women accounted for 51.2 %). The proportion of non-melanoma skin cancer accounted for 17.2 % (16.3 % of men and 18 % of women) of the total number of all reported cancer cases (n = 30,144). The aim of this study is to evaluate the number of clinical relapses in a group of patients. MATERIAL: Retrospectively analyzed data from the medical records of patients with newly detected basal cell carcinoma in period between Jan. 1 2008 to Dec. 31 2013 who underwent surgery and outpatient follow-up at the Department of Ophthalmology and the University Hospital in Bratislava. METHODS: The incidence of relapse was evaluated up to date Dec. 31 2014. We followed the following parameters: location and tumor size, TNM classification, histopathological degree of differentiation, the edges of excised tissue and evaluated recurrence rate separately for each parameter. Statistics were analyzed by chi2 test, which was found to be significant for P < 0.05. The results of continuous parameters were expressed as arithmetic mean ± standard deviation. RESULTS: At the Department of Ophthalmology Faculty of Medicine and UNB, Ruzinov Hospital, in Bratislava, in the period 2008 - 2013 were treated 219 basal cell carcinomas in 217 patients and basal cell carcinoma was histologically confirmed. Basal cell carcinomas were divided into groups according to the stage: G1 (n = 139), G 1-2 (n = 41) and G 2 (n = 39). Localization was more frequent on left side (n = 112) compared to the right one (n = 107). We recorded significantly lower incidence (n = 5) in the area - angulus externus, prevalent occurrence was in the inner area - angulus internus (n = 65). The incidence in the lower eyelid (palpebra inferior) was recorded more frequently (n = 127) as in the upper eyelid (palpebra superior) - (n = 24). During these six years period we have seen 11 recurrences (5.02 %). Exenteration of the orbit was indicated in 5 cases (2.7 %). CONCLUSION: When monitoring patients with newly detected eyelid basal cell carcinoma, operated at the Department of Ophthalmology Faculty of Medicine and UNB in period 2008-2013, incidence of recurrence was recorded in 11 cases, accounting for 5.02 %, which is about one percentage point lower share than in the previous reporting period from period 2005 -2007 from the same Department. The occurrence of relapses corresponds to those in the literature. None of the clinical parameters statistically did affect significantly the incidence of relapses. KEY WORDS: eyelid basal cell carcinoma, non-melanoma skin cancer, tumors eyelashes.
- MeSH
- bazocelulární karcinom epidemiologie patologie chirurgie MeSH
- dospělí MeSH
- incidence MeSH
- lidé středního věku MeSH
- lidé MeSH
- lokální recidiva nádoru epidemiologie patologie chirurgie MeSH
- nádory kůže epidemiologie patologie chirurgie MeSH
- nádory očního víčka epidemiologie patologie chirurgie MeSH
- prevalence MeSH
- retrospektivní studie MeSH
- senioři MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Slovenská republika epidemiologie MeSH
AIM: Primary treatment of basal cell carcinoma of the lower eyelid and the inner corner is essentially surgical, but advanced lesions require extensive surgical interventions. In some cases it is necessary to continue with the mutilating surgery--exenteration of the orbit. In this work we evaluate the indications of radical solutions in patients with basal cell carcinoma invading the orbit and the subsequent possibility for individually made prosthesis to cover the defect of the cavity. MATERIALS AND METHODS: Indications to exenteration of the orbit in patients with basal cell carcinoma findings in 2008-2013. Case report of 2 patients. RESULTS: In period 2008-20013 at the Dept. of Ophthalmology, Comenius University in Bratislava totally 221 patients with histologically confirmed basal cell carcinoma of the eyelids and the inner corner were treated. In 5 cases (2.7 %) with infiltration of the orbit the radical surgical procedure, exenteration was necessary. In 3 patients exenteration was indicated as the first surgical procedure in the treatment of basal cell carcinoma, since they had never visited ophthalmologist before only at in the stage of infiltration of the orbit (stage T4). In one case was indicated exenteration after previous surgical interventions and relapses. After healing the cavity patients got individually prepared epithesis. CONCLUSION: Surgical treatment of basal cell carcinoma involves the radical removal of the neoplasm entire eyelid and stage T1 or T2 can effectively cure virtually all tumors with satisfactory cosmetic and functional results. In advanced stages (T4 stage) by infiltrating the orbit by basal cell carcinoma exenteration of the orbit is necessary. This surgery is a serious situation for the patient and also for his relatives. Individually made prosthesis helps the patient to be enrolled to the social environment.
- MeSH
- bazocelulární karcinom patologie chirurgie MeSH
- biopsie MeSH
- eviscerace orbity metody MeSH
- lidé MeSH
- nádory očního víčka patologie chirurgie MeSH
- oční protézy * MeSH
- retrospektivní studie MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- Check Tag
- lidé MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
BACKGROUND: Nasal tip is one of the most frequent areas affected by basocellular carcinoma. The treatment must avoid any postsurgical deformity, as the nasal tip is the main part of the facial triangle. Most of these patients are elderly and polymorbid. The surgeon must find a compromise between the cosmetic effect and an acceptable stress for the patient. METHODS: There were five methods of nasal tip reconstruction used on a group of fifty elderly patients with various medical comorbidities: skin graft, bilobed flap, dorsal nasal flap, forehead flap and interpolation nasolabial flap. The resulting cosmetic effect was objectivized by a standardized questionnaire and the advantages and disadvantages of each method were discussed. RESULTS: According to the characteristics that were considered (good vascular supply, matching skin color and texture, sufficient amount of material, possibility to cover exposed cartilage or to combine it with cartilaginous graft; scars of minimal visibility, perfect aesthetic outcome, use of local anesthesia, short surgical time, and technical simplicity) was the interpolation nasolabial flap found as the most appropriate. CONCLUSION: Interpolation nasolabial flap is an easy and effective method for treatment of smaller and middle-sized defects of the nasal tip with minimal stress for the patient. LEVEL OF EVIDENCE: Level III.
- MeSH
- bazocelulární karcinom chirurgie MeSH
- chirurgické laloky * MeSH
- estetika MeSH
- lidé středního věku MeSH
- lidé MeSH
- nádory kůže chirurgie MeSH
- nádory nosu chirurgie MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- zákroky plastické chirurgie metody MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
Closure of a nasal tip defect has specific characteristics with regards to the shape, colour, thickness and texture of skin. During the reconstruction it is necessary to observe aesthetic and functional characteristics to achieve an optimal result. There are several methods for closure of a defect in this area. One of the possible techniques is usage of a local flap. In the selection of an optimal procedure it is suitable to consider the aesthetic subunits in the nose. Usage of the V-Y flap is beneficial compared to a rotation flap or a transposition flap, which are associated with significant scaring and deformities, such as a dog-ear. Such conditions may require further corrections later. Erçöçen et al. described a V-Y island dorsal nasal flap, which they used to close a nasal tip defect. The blood supply of the flap was based on the terminal branches of angular artery on both sides (1). In our case report we used the aforementioned flap to close a nasal defect. The flap was based on the terminal branches of the angular artery only on one side.
- MeSH
- bazocelulární karcinom chirurgie MeSH
- chirurgické laloky krevní zásobení MeSH
- lidé MeSH
- nádory kůže chirurgie MeSH
- nádory nosu chirurgie MeSH
- senioři nad 80 let MeSH
- zákroky plastické chirurgie metody MeSH
- Check Tag
- lidé MeSH
- senioři nad 80 let MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
