Divided Nevus Of Eyelid Research Articles

Clinical and immunohistochemical analysis of the verrucous and non-verrucous divided nevus of the eyelids

PurposeDivided nevus with verrucous hyperplasia will always recur after surgery but non-verrucous divided eyelid nevus rarely recur. This study analyzed the differential expression of Ki-67, S100, Melan A and HMB45 and identified the correlation between the clinical and histopathological features of verrucous and non-verrucous divided eyelid nevus.MethodsThis study included 29 patients, of whom 8 patients had verrucous divided nevus. Immunohistochemistry labeling was used to assess the expression of Ki-67, S100, Melan A and HMB45 after excision. The difference between verrucous and non-verrucous divided eyelid nevus was analyzed.ResultsThe patients’ ages ranged from 2 to 59 years, with a mean age of 19 years. The lesion size ranged from 1.5 to 2.0 cm in diameter and invaded the eyelid margins and the posterior lamella of the eyelids. Immunohistochemistry labeling showed strong positivity for approximately 98.5% of S100 and positive staining for approximately 27.6% of Ki-67, 72.4% of Melan A and 6.8% of HMB45. However, Ki-67 was significantly upregulated in verrucous divided nevus of the eyelids compared with non-verrucous divided nevus, with approximately 38.8% upregulation in verrucous and 18.3% upregulation in non-verrucous nevus.ConclusionsThis study correlated the clinic-pathologic features of verrucous divided eyelid nevus by means of statistically analyzing the varied clinical features and pathological impressions. The significant over-expression of S100 may be used as an indicator of divided nevus of the eyelids, and the over-expressed Ki-67 may contribute to the recurrence of verrucous divided nevus. High expression of HMB45 and Melan A may represent malignant transformation.

Application of allogeneic sclera combined with tarso-conjunctival flap in total excision of divided eyelid nevus

To explore the clinical effect of allogeneic sclera transplantation combined with tarso-conjunctival flap in total excision of divided eyelid nevus. Eleven patients (three male and eight female patients) who experienced divided nevus of the eyelids between January 2014 and April 2020 were recruited to this retrospective study. All lesions were thick, darkly pigmented, presented with a wart-like appearance, and invaded the eyelid margin and tarsal conjunctiva. The surgical method involved a full-thickness lesion excision; then, the posterior defect was reconstructed by sliding the residual tarso-conjunctival flap forward and allogeneic sclera transplantation, and the anterior defect was reconstructed with sliding flaps, rotating flaps, and free skin grafts. Neither malignant transformations nor recurrences were observed after a follow-up of more than one year. The eyelid shape was normal, the rim of the eyelid was smooth, there was no dissolution or rejection of the allogeneic sclera, and the eyelid had good mobility. All the flaps used were viable, soft, and thin. The most frequent complication was the loss of eyelashes in the reconstructed area. For divided nevus of the eyelids invaded the eyelid margin and tarsal conjunctiva, total excision is a better decision, regardless of tumor recurrence or aesthetic considerations. The posterior defect reconstruction through sliding residual tarso-conjunctival flaps combined with allogeneic sclera transplantation is simple and effective.

Myocutaneous sliding flap for reconstruction of divided eyelid nevus

ObjectiveTo evaluate the myocutaneous sliding flap for restructuring the eyelid of divided nevus, thus optimizing the aesthetic outcome. DesignA retrospective clinical study. ParticipantsClinical data from patients with a small or medium-sized divided nevus of the eyelids between January 2015 and December 2018 in the Shanghai Ninth People's Hospital were reviewed. MethodsThe safety and efficacy of a surgical approach using a myocutaneous sliding flap were evaluated based on postoperative features and complications. ResultsThis study included 53 patients with an average age was 21.6 years (range, 2–68 years). The lesions involved the inner canthus in 5 patients (9.43%) and the lateral canthus in 14 patients (26.42%). Three (5.66%) patients had undergone primary surgery elsewhere. Overall, the eyelid margins were in good shape postoperatively at an average follow-up of 22.7 months, and there were no obvious eyelid deformities, lagophthalmos, or other unacceptable complications postoperatively. The nevi were benign intradermal (60.38%), junctional (16.98%), and compound types (22.64%) without malignant transformation, as confirmed by pathologic examination. No malignant transformation was observed until the end of the follow-up period. ConclusionA myocutaneous sliding flap can provide an appropriately size pedicle graft and achieve satisfactory cosmetic results for divided eyelid nevus.

Reconstruction of the Congenital Divided Nevus of the Eyelids and Proposal of New Classification.

Background:Divided nevus is a rare form of congenital nevus that usually occurs on both upper and lower eyelids of one eye, forming one large nevus when the eyelids are closed. Typically, congenital melanocytic nevi of the body are classified according to their size (small < 1.5 cm, medium 1.5–20 cm, and large > 20 cm). However, because divided nevus of the eyelids is usually relatively small, this classification may be too coarse and not adequate. Furthermore, there is no practical classification for divided nevus of eyelids yet.Methods:We treated 3 cases of medium and large congenital divided nevus of the eyelids using local flaps based on the idea of esthetic subunits. Also, we proposed a new classification especially for congenital divided nevus of the eyelids based on the idea of esthetic subunits.Results:All patients were treated successfully with the reconstructive idea of esthetic subunits for the eyelids. Case 1 (medium size) was reconstructed by orbicularis musculocutaneous flap and case 2 (large size) was reconstructed by expanded flap, and case 3 (medium size) was treated by modified V-Y orbicularis oculi musculocutaneous flap. In all cases, the flap color and texture were well matched and satisfactory results were obtained. Also, by using the new classification, we were able to plan practical scheme for divided nevus reconstruction.Conclusions:The use of our proposed classification and esthetic subunits for the divided nevus of the eyelids allows systematic surgical planning, leading to improved reconstructive outcomes.

Staged Surgery with Total Excision and Lamellar Reconstructive for Medium-sized Divided Nevus of the Eyelids.

To explore a prior treatment strategy for medium-sized (1.5-20 cm) divided nevus of the eyelids. Six patients who suffered from divided nevus of eyelids were recruited to this prospective, case series study between July 2008 and January 2014 (4 male and 2 female patients). The patients' ages ranged from 14 to 29 years, with an average age of 24.5 years. All lesions were medium-sized (1.5-20 cm in diameter) and invaded eyelid margins and the posterior lamella of eyelids. Staged surgery involved total excision of lesions and then repair of the defects with advanced skin flaps and tarsoconjunctival flaps. Two staged surgeries were completed at intervals of at least 3 months. All of the patients were followed up at least 3 months after the second surgery. Malignant transformation and recurrence were not observed. All of the flaps survived well, and all of the donor sites were healed with inconspicuous scarring. The only complication was eyelash sacrifices, and 5 of 6 patients suffered from this complication. Excellent cosmetic results were gained in all patients, with the exception of 1 patient who thought his postoperative appearance was only good because of the impalpable disparity in color and thickness between the skin flaps and recipient sites. A staged surgery approach with the total excision of lesions and lamellar reconstructive procedures to repair the defect is a reasonable treatment strategy and can achieve satisfactory cosmetic results for medium-sized (1.5-20 cm in diameter) divided nevus of eyelid.

Divided Eyelid Nevus: A Lid-Sparing, Staged Surgical Approach

To describe a method for staged partial resection of congenital divided eyelid nevus. The rationale, technique, and outcomes for this approach are described. Retrospective chart review of a case series. Clinical records of 12 patients with divided eyelid nevus were reviewed with attention to presenting features, surgical management, histopathology, and follow-up course. Surgical approach involved the use of bipolar and thermal cautery to ablate the eyelid margin component, skin excision for cutaneous lesions, and then repair with advancement flaps or skin grafting. Eight patients with divided nevus were treated with a staged surgical approach: 5 primarily and 3 as revision cases. Average age was 16.3 years at primary presentation (range, 2-36 years), 16.5 years at initial surgery (range 2-36 years), and 36.0 years at presentation for revision (range, 12-72 years). Primary patients required 1 (n = 3) or 2 (n = 2) surgeries. Revision patients required 2 (n = 1) or 3 (n = 2) procedures in addition to those they had already undergone. Anterior lamellar repair was by granulation (n = 2), local skin flaps (n = 3), or skin grafts (n = 3). Average follow-up was 21.6 months (range, 0-98 months). No adverse effects or malignant transformations were seen. Patients with divided eyelid nevi often present for surgical management because of cosmetic and functional concerns. Because small-to-medium congenital nevi have a low risk of malignant transformation, total excision may not be necessary. A staged surgical approach with cautery ablation and contouring of the eyelid margin component and surgical resection of the anterior lamellar portion may be a reasonable treatment strategy for these patients.

Study of surgical techniques of divided nevus of eyelids

To investigate the surgical techniques of divided nevus of the eyelids with different locations and sizes. Retrospective observational case series. Thirty cases (30 eyes) of divided nevus of the eyelids in Zhongshan Ophthalmic Center from July 1997 to November 2006 were retrospectively reviewed. There were three different surgical methods. Excision of the nevus and direct suture after excision in 3 cases. Excision of the nevus and free skin graft transplantation in 5 cases. Excision of the nevus and transfer of skin flap, which included a two stages reconstruction, was performed in 22 cases. The upper or lower eyelid was treated first and another eyelid was treated after three months. Lacrimal punctum and lacrimal canaliculus were excised if they were involved in 8 cases among 22 cases. The mean follow-up time was 60 months (ranging from 2 years to 11 years). Only one case recurred after two years during follow-up and was excised after five years. Pathologic examination indicated malignant transformation. Excision with histopathological control was performed and the nevus did not recur during follow-up time. Recurrence or malignant transformation did not occur in other cases. Aesthetical results of skin flap transplantation were better than skin graft transplantation. The results of two stages reconstruction and transfer of skin flap after excision of the divided nevus are better than free skin graft transplantation. Close observation is required after excision of the divided nevus for early detection of malignant transformation.

Treatment of Divided Eyelid Nevus With Island Skin Flap: Report of Ten Cases and Review of the Literature

Three different techniques used in 10 cases of divided eyelid nevus and the results are reported and discussed. A retrospective study of 10 patients who had undergone treatment of divided eyelid nevus with skin flap between March 2003 and March 2008 was conducted. According to the location, shape, and size of the upper and lower eyelids nevus orbicularis oculi musculocutaneous flap, postauricular superficial musculoaponeurotic system (SMAS)-pedicled flap, or reversal superficial temporal artery (STA) flap was designed to repair the eyelid defects. Ten patients were treated in this series with 10 oculi musculocutaneous flaps, 3 postauricular SMAS-pedicled flaps, and 3 reversal STA flaps. One postauricular SMAS-pedicled flap and 1 reversal STA flap showed distal flap venous refluence (reflux) obstruction and partial epidermal necrosis in the early postoperative stage, but after active treatment, they healed well and needed no surgical revision. All the other flaps survived well. Four flaps showed slight trapdoor deformation needing no revision. No other complication developed during the follow-up periods of 6 to 36 months. All the donor sites were closed directly and healed well with inconspicuous scarring. This series has exhibited satisfactory cosmetic and functional results. Treating divided eyelid nevus with well-selected skin flaps is satisfying with excellent color and texture matching, normal eyelid function, and inconspicuous donor deformity.