Roentgen Therapy of Carcinoma of the Skin of the Eyelids

Abstract

Carcinomas of the skin of the eyelids are frequently diagnosed in a relatively early stage; they may become serious therapeutic problems, however, depending upon the character and the adequacy of the treatment that is first instituted. Carefully planned curie therapy or a surgical excision and subsequent plastic repair are capable of controlling these tumors; but, while no greater certainty of control of the lesion is offered, the functional and esthetic results of such hazardous or elaborate procedures are far from comparable with those which are obtained by the judicious application of roentgen therapy. Incidence In the first six years of work, 1,343 consecutive basal-cell carcinomas, 439 epidermoid carcinomas, and 2 adenocarcinomas of the skin of the face, which had received no previous treatment, were observed in the Ellis Fischel State Cancer Hospital; 12 per cent of the basal-cell carcinomas and 1 per cent of the epidermoid carcinomas arose from the skin of the orbit. This report is based on 168 consecutive cases of carcinoma of the skin of the eyelids, and of the inner and outer canthi, in patients who were admitted from May 1940 to December 1945, who have now been followed for a minimum of three years; this series includes 21 patients with a recurrence following previous inadequate treatment. A proportion of one female for every three males is found in our series of carcinomas of the skin of the face. In the group of carcinomas of the skin of the orbit the proportion of females is slightly higher. Our 168 lesions were observed in 163 patients, of whom 108 were men and 55 women. Our youngest patient was thirty-five years old, and the oldest eighty-nine years; the average age was sixty-seven years and the median age seventy years. It may be significant that women were in the majority among the younger patients; 19 of the 35 patients under sixty years of age were females (Table I). Clinical Aspects Most carcinomas of the skin of the orbit arise from the middle or lateral third of the lower eyelid near its ciliary border; next in frequency are the carcinomas of the inner canthus developing around or under the lacrimal caruncle: 80 per cent of the carcinomas of this series arose from the lower eyelid or inner canthus (Table II). The growth usually presents well defined limits with no visible ulceration or a small central loss of substance (Fig. 3); less frequently the carcinoma arises from a preexisting area of dyskeratosis and there may be an ill-defined superficial ulceration. Even the advanced lesions seem to stop at the ciliary border and do not infiltrate the palpebral conjunctiva. We have observed a few lesions, however, in which the carcinoma presented no bulk but involved the entire ciliary border of the lower lid, producing a long and narrow ulceration and shortening the height of the lid at the expense of both the cutaneous and conjunctival aspects.