Adjuvant Cryotherapy Research Articles

Recurrent Primary Acquired Melanosis With Atypia Involving a Clear Corneal Phacoemulsification Wound

To report a case of corneal primary acquired melanosis (PAM) with atypia after cataract surgery. Retrospective case report with literature review. Excision of an elevated pigmented conjunctival lesion was performed at the time of cataract extraction by clear corneal phacoemulsification by an outside surgeon. Histopathologic examination revealed PAM with atypia. Three months after the initial surgery, recurrent melanosis involving the peripheral corneal epithelium was noted, with extension of pigment into the corneal stroma through the paracentesis site. Excision of the involved corneal epithelium and the adjacent conjunctiva was performed, and microscopically recurrent PAM with atypia was confirmed. Adjuvant cryotherapy was applied at the time of surgery, and topical mitomycin C was given postoperatively. Repeat biopsies revealed no remaining malignancy, and the intrastromal pigment has disappeared during 18 months of follow-up. We present this case to illustrate the importance of complete evaluation and treatment of potentially atypical melanocytic conjunctival lesions before proceeding with elective intraocular surgery.

Conjunctival melanoma: pitfalls and dilemmas in management

The current dilemmas in the diagnosis and management of conjunctival melanoma are reviewed in this paper. Available evidence for the role of sentinel lymph node biopsy as it applies to conjunctival melanoma is examined. The incidence of conjunctival melanoma appears to be on the rise. Analyses of 770 patients with conjunctival melanoma reveals a nearly 50% rate of local recurrence, and up to a 38% 10-year mortality. Adverse outcomes can be minimized by adjuvant therapies and 'no touch' techniques at the time of initial surgery. The metastatic spread occurs via both lymphatic channels and hematogenously. Sentinel lymph node biopsy does not appear to have a significant impact on survival or subsequent treatment. The management of conjunctival surface melanomas is complicated by local recurrence and metastatic disease, particularly for lesions greater than 2 mm in thickness and arising from nonbulbar conjunctiva. Early complete excision with appropriate adjuvant cryotherapy and topical chemotherapy may be curative in some patients. Conjunctival anatomy and high recurrence rate with resultant metastatic spread undermines the utility of sentinel lymph node biopsy in this condition. Further research and innovation for detection of systemic micrometastases and treatment of metastatic disease are needed.

Сold treatment and alloplasty for a resection defect of an extensive giant cell tumour in the proximal tibia (description of a case)

The WHO Histological Classification of Tumours considers the giant cell tumor of bone (GCTB) (osteoclastoma) as potentially malignant. Currently, the need for surgical treatment of this pathology is beyond doubt. The efficacy of surgical intervention in such patients significantly reduces as result of a high tendency of GCTB to recur. The use of adjuvant cryotherapy in treatment of GCTB made it possible to reduce the number of local recurrences down to 3.5 %. Thus, the cryosurgical technique of treatment with alloplasty of the resection defect is still an effective way of treatment, which makes it possible to avoid mutilating surgery.

Management of conjunctival melanoma

Invasive conjunctival melanoma can arise de novo, from nevus or from melanoma in situ. The literature reports that after treatment of invasive conjunctival melanoma more than 50% of patients develop local tumor recurrence, with 20% eventually requiring orbital exenteration and 20–30% developing fatal metastasis. Our results have improved since we replaced adjuvant cryotherapy with radiotherapy and topical chemotherapy. There is scope for multicenter clinical trials and translational research, but these require consistent staging and grading of disease. We propose that the term ‘primary acquired melanosis’ should only be used clinically, when the histology is not known. We have devised a clinical system for mapping conjunctival melanocytic lesions and a system for scoring the histological grade of atypia of conjunctival melanocytic intra-epithelial neoplasia/melanoma in situ. We anticipate that these measures will improve outcomes after treatment of conjunctival melanoma in situ and invasive melanoma.

Cytotoxic Effect of Sodium Hypochlorite 0.5% (NaOCl) on Ocular Melanoma Cells In Vitro

Purpose: Excision with or without adjuvant cryotherapy or brachytherapy is the treatment of choice in conjunctival melanoma. Adjuvant rinsing with alcohol or sodium hypochlorite peroperatively (Dakin's solution) is used in some centers to prevent seeding of melanoma cells. The purpose of this research is to compare the cytotoxicity of sodium hypochlorite (NaOCl) with other potential cytotoxic solutions in the treatment of conjunctival melanoma. Methods: Three uveal melanoma cell lines (OCM8, Mel285, and Mel270) and one conjunctival melanoma cell line (CM2005.1) were tested in a proliferation test (CellTiter 96 AQueous One Solution Cell Proliferation Assay, Promega, Madison, WI). The 96-well plates were coated with melanoma cells and treated with sodium hypochlorite 0.5%, sodium bicarbonate (1.4% and 8.4%), ethanol 99%, or sodium chlorite during 3, 5, or 15 minutes. Each solution was tested in several dilutions. Results: In all cell lines, no surviving cells were observed after treatment of 3 minutes with sodium hypochlorite. Ethanol 99% had a similar effect. A reduction of 70% of viable cells could be reached using sodium bicarbonate 1.4% or 8.4%. Water reduced the amount of viable cells by 40%. Conclusions: Sodium hypochlorite is cytotoxic for melanocytic cells in vitro. Its use may reduce local seeding of tumor cells and may decrease metastasis after extirpation of an extended ocular tumour. Further in vivo evaluation of sodium hypochlorite is required.

Vocal Outcomes After Laser Resection of Early-Stage Glottic Cancer With Adjuvant Cryotherapy

To evaluate the vocal outcomes of patients with early-stage glottic carcinoma undergoing laser resection with adjuvant cryoablative therapy. Retrospective review. Tertiary care center. Patients Twenty patients with early-stage glottic carcinoma. Intervention Treatment of early-stage glottic carcinoma with endoscopic carbon dioxide laser resection in conjunction with cryoablation. Disease-free survival and subjective and objective measures of posttreatment voice quality, based on serial videolaryngostroboscopy. There was 1 local treatment failure, with an overall mean disease-free follow-up of 32.6 months (range, 3-93 months). Carbon dioxide laser resection and cryoablative therapy were associated with a significant improvement in subjective voice quality (P<.001). Long-term dysphonia was uniformly improved vis-à-vis the pretreatment condition, even among patients with the most advanced disease undergoing the widest resections. Posttreatment web formation was not noted among 4 patients with anterior commissure involvement. Endoscopic laser laryngeal surgery performed in conjunction with cryotherapy for early-stage glottic carcinoma yielded excellent primary site control, while improving subjective and objective measures of voice quality. Combined laser surgery and cryotherapy is a possible alternative to radiotherapy for selected patients with early-stage glottic carcinoma who desire curative therapy, while optimizing vocal outcomes.

Vocal Fold Healing after Laser Cordectomy with Adjuvant Cryotherapy

To understand the effect of adjuvant cryotherapy on glottic wound healing after endoscopic CO2 laser cordectomy. Canine acute injury model with videolaryngostroboscopic and histopathologic outcomes analysis. Twelve adult male dogs underwent bilateral endoscopic CO2 laser transmuscular cordectomy followed by randomized unilateral endoscopic glottic cryotherapy. The animals were randomly divided into four groups and underwent videolaryngostroboscopy followed by sacrifice at 0, 2, 6, and 12 weeks postoperatively. Three untreated male dogs served as controls. Histopathologic sections were prepared with Alcian blue, Giemsa, hematoxylin-eosin, movat's, Masson's trichrome, and picrosirius stains. Videostroboscopy demonstrated an earlier restoration of glottic volume and a return of mucosal waves among vocal folds treated with combined therapy by 6 weeks posttreatment. The mean depth of inflammatory reaction in the vocal cords treated with combined therapy was 1.07 mm versus 1.15 mm in vocal cords treated with CO2 laser therapy alone. At 2 and 6 weeks postoperatively, combined treatment was associated with a decreased volume of collagen. At 12 weeks postoperatively, combined treatment was associated with greater collagen organization, normalized collagen histoarchitecture, and decreased keratinization. Adjuvant cryotherapy appears to alter glottis-specific wound healing, leading to decreased and more organized collagen formation and decreased keratinization with a resultant improvement in glottic function, when compared with CO2 laser surgery alone, in an acute canine injury model. Studies in humans are ongoing to further evaluate the clinical potential of cryotherapy on glottic wound healing.

Hughes Technique, Amniotic Membrane Allograft, and Topical Chemotherapy in Conjunctival Melanoma With Eyelid Involvement

A 59-year-old woman presented with a pigmented mass in the inferior tarsal conjunctiva of the left eye with an associated diffuse, multifocal pigmentation involving largely the inferior half of the bulbar conjunctiva, fornix, and eyelid skin. Histopathologic examination of map biopsies disclosed conjunctival melanoma from primary acquired melanosis. Surgical excision of the inferior bulbar conjunctiva, fornix, and lower eyelid with histopathologic free margins was performed. Adjuvant cryotherapy was applied. The bulbar conjunctiva and lower fornix were reconstructed with an amniotic membrane allograft. Lower eyelid reconstruction was accomplished by use of the Hughes technique. Topical mitomycin C (0.04%) was applied after surgery. After 2 years of follow-up, no tumor recurrence has been detected and the eyelid and conjunctival defect have been satisfactorily corrected. This combined surgical procedure using amniotic membrane allograft and a composite tarsoconjunctival flap is shown to be useful in the treatment of an advanced conjunctival neoplasia with extensive eyelid involvement.

Conjunctival Melanoma Arising From Diffuse Primary Acquired Melanosis in a Young Black Woman

To report a case of conjunctival melanoma arising from diffuse primary acquired melanosis (PAM) with atypia in a young black woman in the context of previously published cases of this lesion in blacks. Retrospective case report with literature review. The number and percentage of conjunctival melanomas occurring in black patients were determined from case series in which race was specified, published from 1950 to the present. Nodular multifocal conjunctival melanoma in a 30-year-old black woman was treated using surgical excision and adjuvant cryotherapy. Extensive PAM with severe atypia, including areas of microinvasive melanoma, was treated using topical mitomycin C. Literature review revealed 35 cases of conjunctival melanoma occurring in black patients. No previous reports of mitomycin C use in black patients with melanoma or PAM were identified. Conjunctival melanoma is an exceedingly rare tumor in black patients. The current case brings the total of reported cases to 36. We successfully treated nodular melanoma and diffuse PAM in a young black woman using a combination of excision with cryotherapy and topical mitomycin C, suggesting that these lesions are amenable to the same types of therapy previously described for white patients.

Malignant melanoma of the conjunctiva.

Conjunctival melanoma is a relatively rare ocular malignancy with substantial associated morbidity and mortality. More than 100 articles on conjunctival melanoma were reviewed, including most of the relevant recent publications cited in a current MEDLINE search. The author's experience with conjunctival melanomas is also incorporated in this review. Recognition of their precursor lesions at an early stage is important. Staging of the disease by sentinel lymph node biopsy is now advocated in some centers. Surgical excision with adjuvant cryotherapy and alcohol corneal epithelialectomy is usually effective in eradicating most of these lesions. Extensive cases of flat primary acquired melanosis with atypia may be managed with mitomycin C. Multifocal and advanced melanoma, especially in cases showing intraocular or orbital invasion, may require exenteration and/or radiotherapy to adequately extirpate the neoplasm locally. However, systemic metastases already may have occurred in these patients with advanced disease. Conjunctival melanoma is a condition of concern because of its rarity and lethal potential. Advances in the understanding and management of this neoplasm have markedly reduced the mortality and possibly the morbidity associated with this malignancy.

Malignant Melanoma Arising From Unusual Conjunctival Blue Nevus

Cellular blue nevus is an uncommon pigmented tumor in the conjunctiva, where it generally appears as a deep, circumscribed, pigmented conjunctival mass. We report a case of conjunctival blue nevus that clinically resembled primary acquired melanosis and gave rise to conjunctival melanoma. A 41-year-old man developed a diffuse pigmented mass in the inferior fornix of his left eye. Over a 20-year period, he noted slight progression of the pigment. Foci of epibulbar pigmentation were also present. The lesion resembled primary acquired melanosis. Excisional biopsy and adjuvant cryotherapy were performed. Histopathologic examination disclosed an intense infiltrate of heavily pigmented dendritic melanocytes with aggregates of less pigmented plump cells in the substantia propria. The conjunctival epithelium was normal. Malignant cellular features consistent with melanoma were observed in some foci. Cellular blue nevus of the conjunctiva can simulate primary acquired melanosis and can give rise to malignant melanoma. Arch Ophthalmol. 2000;118:1581-1584

Mucoepidermoid carcinoma of the conjunctiva: A series of three cases

Objective To detail the clinical presentation and outcomes of currently available treatments for mucoepidermoid carcinoma of the conjunctiva (MCC). Design Retrospective noncomparative case series. Participants Three patients ranging from 40 to 63 years of age with MCC participated. Intervention Excisional biopsies and various therapies were performed. Main outcome measures Clinical and surgical outcomes were measured. Results Patient 1 is a 55-year-old man with right temporal MCC. He underwent two local excisions with adjuvant cryotherapy and has had no recurrence at 31 months follow-up. Patient 2 is a 63-year-old man with right temporal MCC who underwent fractionated iodine 125 plaque radiotherapy. He had a recurrence approximately 8 months after plaque treatment and subsequently underwent enucleation of the right eye. Clinical follow-up examinations revealed no further recurrence at 17 months. Patient 3 is a 40-year-old woman treated for right MCC with carbon dioxide laser with recurrence at 3 weeks. She subsequently underwent radiation treatment with the development of regional lymph node metastases 16 months later. Conclusions MCC is a rare neoplasm that displays an extraordinary capacity for aggressive local invasion. This series of three case reports demonstrates the high recurrence rate of MCC and the response of this tumor to different current modalities of treatment. Extended follow-up is required with this tumor because distant metastases can occur very late.

Massive Corneal and Conjunctival Squamous Cell Carcinoma

A patient with massive, protuberant squamous cell carcinoma of conjunctiva invading the whole cornea, so as to hang from the surface, was referred with a visual acuity of hand motion near to face. A microscopically-controlled, frozen section guided excision, followed by double-freeze-thaw cryoapplication to the sclera and the edges of the conjunctival bed and lamello-lamellar sclerokeratoplasty, was performed. Three years later the patient's visual acuity was 20/60 with no evidence of recurrence of the lesion. Frozen section guided excision with adjuvant cryotherapy and lamellar sclerokeratoplasty is a viable therapy for massive squamous cell carcinoma of cornea and conjunctiva.

ANEURYSMAL BONE CYSTS TREATED BY CURETTAGE, CRYOTHERAPY AND BONE GRAFTING

We treated 26 patients with 27 aneurysmal bone cysts by curettage and cryotherapy and evaluated local tumour control, complications and functional outcome. The mean follow-up time was 47 months (19 to154). There was local recurrence in one patient. Two patients developed deep wound infections and one had a postoperative fracture. We compared our results with previous reports in which several different methods of treatment had been used and concluded that curettage with adjuvant cryotherapy had similar results to those of marginal resection, and that no major bony reconstruction was required. We recommend the use of cryotherapy as an adjuvant to the surgical treatment of aneurysmal bone cysts. It provides local tumour control. Combination with bone grafting achieved consolidation of the lesion in all our patients.

Aneurysmal bone cysts treated by curettage, cryotherapy and bone grafting.

We treated 26 patients with 27 aneurysmal bone cysts by curettage and cryotherapy and evaluated local tumour control, complications and functional outcome. The mean follow-up time was 47 months (19 to 154). There was local recurrence in one patient. Two patients developed deep wound infections and one had a postoperative fracture. We compared our results with previous reports in which several different methods of treatment had been used and concluded that curettage with adjuvant cryotherapy had similar results to those of marginal resection, and that no major bony reconstruction was required. We recommend the use of cryotherapy as an adjuvant to the surgical treatment of aneurysmal bone cysts. It provides local tumour control. Combination with bone grafting achieved consolidation of the lesion in all our patients.