Хирургическое лечение базалиомы внутреннего угла глазной щели с закрытием дефекта свободным лоскутом. Клинический случай

Abstract

Basal cell carcinoma is a tumor of the basal layer of the skin epithelium. It occupies an intermediate position between benign and malignant tumors. It develops from atypical basal cells of the epidermis and follicular epithelium. It does not metastasize. The occurrence on the lower eyelid is about 65 %, on the medial canthus about 15 %, on the upper eyelid about 15 % and on the lateral canthus 5 % of cases. Usually the neoplasm is painless, but more invasive basal cell carcinomas with perineural germination into the tissues of the eyelid and orbit can cause pain [1, 3]. The choice method of treatment of this disease is surgical. The operation is performed under a microscope, which allows to remove the altered tissues as much as possible and correctly match the edges of the donor material. To replace the surgical defect, a type of plastic was chosen: plastic with local tissues, free skin plastic. The skin flap was taken from the upper eyelid of the fellow eye [2]. There are several types of basal cell carcinomas: nodular, flat, and superficial. The nodular form is most common. A distinctive feature in most cases is pearl shade and waxy or translucent consistency of the tumor, more noticeable on the raised edges of the neoplasm. A characteristic and important symptom is telangiectasis marked at the edges of the neoplasm [1]. Initially, a painless nodule appears on the skin gradually, the nodule spreads over the area, accompanied by formation of ulcers, due to disturbance of blood supply and turns into ulcerative-nodular form. Ulceration can bleed. Further, basal cell carcinoma turns into a flat plaque with a peeling surface, a node protruding above the surface of the skin, or into a deep ulcer that destroys the underlying tissues. With advanced forms or inadequate treatment, the tumor can grow into the lacrimal pathways, the orbit and occasionally into the cranial cavity. The sprouting of orbital tumor causes diplopia and dislocation of the eyeball. Spontaneous regression is rare [3]. There are the following types of treatment: radiation, surgical, combined, medicinal, cryogenic, laser [4, 5]. Radiation, laser, cryogenic methods of treatment are carried out in a specialized cancer center. The surgical method is based on excision within healthy tissues with the least traumatization or destruction of surrounding tissues. Excision of a part of the eyelid weakens its horizontal tension; this circumstance requires special restorative techniques to prevent scarring. The choice method of the defect closure is the method of lateral displacement, plastic with a free flap or pedicle flap [4, 5]. Key words: basal cell carcinoma; surgery of basal cell carcinoma; plastic surgery with a free flap.