Eyelid Cancers Research Articles

Eyelid Malignancies- Always Quite Challenging

The diagnosis and management of eyelid cancers are quite challenging. Eyelid tumours are relatively rare diverse group of diseases varied in their presentation and extent. Many benign tumours and inflammatory conditions quite frequently masquerade eyelid cancers. Eyelid cancers are not single entity but comprise a wide range of tumours with extremes of tumour biology from indolent to very aggressive histopathologic types. Compromise on aesthetics and eyelids' indispensable function of protecting the eyes during management, may lead to untoward cosmetic disfigurement and loss of vision. On the other hand, inadequate cancer clearance will also be vision threatening and life threatening due to loco regional recurrence and metastasis. To strike an optimal balance is a challenging task, to achieve 'cancer cure' with maximum preservation of function and cosmetics. In addition, the integration of other modalities of treatment, judicious selection and their sequencing require multidisciplinary discussion and joint management by different specialists. We are presenting four case scenarios, we met with in our teaching hospital with reference to literature review to emphasize that eyelid malignancies are not always simple with respect to diagnosis and management.

A Case of Parotid Metastasis after Eyelid Cancer Operation

There are various types of malignancy in eyelid, such as squamous cell carcinoma, melanoma, and sarcoma. These malignant tumors have potential of metastasis by regional lymph node drainage. The lymph node around parotid gland has been known as a common site of regional lymph node metastasis. The rarity of malignant tumors in the periorbital area makes it difficult to determine the optimal extent of treatment. We report a case of parotid metastasis after eyelid cancer operation in a 60-year-old man.

Developing the Adult Male ICRP Phantom and Evaluation the Absorbed Dose Received By Critical Organs in Head and Neck Region during the Radiotherapy of Eye Cancer

Introduction Accurate estimation of the absorbed dose in radiosensitive organs, located away from the target volume during radiotherapy, is one of the main reasons for the development of reference phantoms. The International Commission on Radiological Protection (ICRP) reference phantoms can provide a more realistic view of the human anatomy in comparison with the previously used mathematical phantoms. However, the ICRP reference phantoms seem to have certain limitations, resulting in the inaccurate eye simulation due to the absence of super-high-resolution CT scan images. Materials and Methods In this study, we developed a modified version of the ICRP reference phantom by inserting a realistic eye phantom into the voxelized phantom. In addition, by using the developed model, the absorbed dose received by sensitive organs (e.g., thyroid, brain, and different parts of the eye) during radiotherapy of a common ocular surface tumor was determined. The results were compared with those obtained by the modified phantom developed by the University of Florida-Oak Ridge National Laboratory (UF-ORNL). Results Based on the results, the relative difference between the equivalent doses calculated by the developed phantom and UF-ORNL phantom was nearly 75-95% and 3% for thyroid and eye substructures, respectively. Conclusion Despite of many advantageous of voxel phantoms, they have considerable limitation in providing accurate model of the eye. In the present study, a detailed stylized model was developed and incorporated into the Adult Male (AM) reference and UF-ORNL phantoms. These phantoms were then used for the dosimetric calculations during eyelid cancer therapy.

A study of role of brachytherapy IR192 in treatment of eyelid tumors

Background: In eye lid cancers, there is a significant risk for tissue damage to nearby vital ocular structures and even of blindness. The skin around the eyelid is thin and contains little subcutaneous tissue and anatomic connections to the underlying bone in the region facilitate rapid local tumor spread into the nasal and orbital cavities. Objective: The aim of this study was to evaluate the response of high dose rate interstitial brachytherapy in carcinoma eye lid. Methodology: From January 2011 to December 2012, 25 diagnosed cases of carcinoma eye lid were reported in our department. All cases were staged clinically according to the TNM staging system. All patients were treated with high dose rate interstitial implant and analyzed for presence of residual disease, local recurrence, distant metastasis, radiation reaction and disease free survival. Result: Total 25 cases were examined, 12 were males while 13 were females. Most of the tumors were involving the lower lid. Squamous cell carcinoma out numbered the basal cell carcinoma. Basal cell carcinoma group of 11 cases, 91% showed complete regression at 6 months while Squamous cell carcinoma group of 14 cases, 93% showed total regression. Conclusion: High dose rate interstitial brachytherapy with Iridium 192 is appropriate for the treatment of early staged squamous cell carcinoma of eye lid.

Metastatic eyelid cancer from gastric adenocarcinoma

Metastatic eyelid cancer from gastric adenocarcinoma

Differential senescence capacities in meibomian gland carcinoma and basal cell carcinoma.

Meibomian gland carcinoma (MGC) and basal cell carcinoma (BCC) are common eyelid carcinomas that exhibit highly dissimilar degrees of proliferation and prognoses. We address here the question of the differential mechanisms between these two eyelid cancers that explain their different outcome. A total of 102 confirmed MGC and 175 diagnosed BCC cases were analyzed. Twenty confirmed MGC and twenty diagnosed BCC cases were collected to determine the telomere length, the presence of senescent cells, and the expression levels of the telomere capping shelterin complex, P53, and the E3 ubiquitin ligase Siah1. Decreased protein levels of the shelterin subunits, shortened telomere length, over-expressed Ki-67, and Bcl2 as well as mutations in P53 were detected both in MGC and BCC. It suggests that the decreased protein levels of the shelterin complex and the shortened telomere length contribute to the tumorigenesis of MGC and BCC. However, several parameters distinguish MGC from BCC samples: (i) the mRNA level of the shelterin subunits decreased in MGC but it increased in BCC; (ii) P53 was more highly mutated in MGC; (iii) Siah1 mRNA was over-expressed in BCC; (iv) BCC samples contain a higher level of senescent cells; (v) Ki-67 and Bcl2 expression were lower in BCC. These results support a model where a preserved P53 checkpoint in BCC leads to cellular senescence and reduced tumor proliferation as compared to MGC.

Trends of eye lid carcinoma in Chhattisgarh state of India and their outcome with high dose interstitial brachytherapy

Introduction: Sight is the most precious of all senses. Tumors of the eye and orbit can be life threatening and causes blindness and disfiguring. In planning management the threat to life with disfigurement is the primary issue to be faced with, the best treatment aimed is to cure and long term control having priority. With this aim our study is to report the trend of eyelid cancer in Chhattisgarh state of India and their outcome with High Dose Rate Interstitial Brachytherapy. Material and Methods: Thirty Six Patients with histo-pathologically confirmed malignant eyelid tumours previously untreated and registered at the Department of Radiotherapy, Pt. J.N.M. Medical College and Regional Cancer Centre, Raipur, were considered in the present study. Registered patients were classified to find out general trend of occurrence in Chhattisgarh, India. Post- treatment patients were reviewed for five years to study the outcome of high dose rate interstitial brachytherapy (HDRIBRT) of eyelid cancer. Results and Discussion: Male predominance was seen in the patients of eyelid tumors. The occurrence of eyelid tumour was found higher (72.2%) in the patients with age above 60 years and 27.8% were less than 60 years old. Anatomically majority of malignancies found in upper eyelid than lower eyelid. Post Treatment follow up ranged from 10 months to 5 years in which all the patients remained locally controlled. Conclusions: Histo-pathologically SCC predominantly found in males than female. The excellent results of interstitial brachytherapy prove that it may be one of the efficient modality for the treatment of carcinoma eyelid.

Interstitial high-dose-rate brachytherapy in eyelid cancer.

To report the experience and the outcomes of interstitial high-dose-rate (HDR) brachytherapy (BT) of eyelid skin cancer at the Department of Radiotherapy of Hospital de Santa Maria in Lisbon. Seventeen patients (pts; mean age, 73.75 years) who underwent eyelid interstitial HDR BT with an (192)Ir source between January 2011 and February 2013 were analyzed. Lesions were basal (94%) and squamous (6%) cell carcinomas, on lower (88%) or upper (6%) eyelids, and on inner canthus (6%). T-stage was Tis (6%), T1 (46%), T2 (36%), and T3a (12%). The purpose of BT was radical (12%), adjuvant to surgery (71%), or salvage after surgery (18%). The BT implant and treatment planning were based on the Stepping Source Dosimetry System. The median total dose was 42.75 Gy (range, 32-50 Gy), with a median of 10 fractions (range, 9-11 fractions), twice daily, 6 h apart. The median V100 was 2.38 cm(3) (range, 0.83-5.59 cm(3)), and the median V150 was 1.05 cm(3) (range, 0.24-3.12 cm(3)). At a median followup of 40 months (range, 7-43 months), the local control was 94.1%. There was one local recurrence and one non-related death. The BT was well tolerated. Madarosis was the most common late effect (65% of pts) and was related with higher values of V100 (p = 0.027). Cosmetic outcomes were good and excellent in 70% of pts. Interstitial HDR BT is a feasible and safe technique for eyelid skin cancers, with good local control. Recurrent lesions and higher volumes receiving the prescribed dose were associated with worse outcomes.

Eyelid and ocular surface carcinoma: Diagnosis and management

Eyelid cancers account for 5% to 10% of all cutaneous malignancies. The incidence of eyelid cancer is approximately 15 cases per 100,000 individuals per year. Basal cell carcinoma is by far the most common cutaneous malignancy in the periocular area; other cutaneous malignancies that occur in this area include, in decreasing order of frequency, squamous cell carcinoma, sebaceous carcinoma, melanoma, and Merkel cell carcinoma. The most common treatment for eyelid carcinomas is surgical resection with frozen section examination for margin control, but exenteration may be needed when there is orbital invasion. Adjuvant radiotherapy may be needed in patients at high risk for local recurrence; sentinel lymph node biopsy may be considered in patients at high risk for lymph node metastasis. Primary or residual in situ disease of the conjunctiva can be treated with topical chemotherapy, such as mitomycin C, 5-fluorouracil, or interferon alpha-2 b. For patients with metastatic or locally advanced basal cell or squamous cell carcinoma not amenable to surgical excision or radiotherapy, targeted therapy against the hedgehog pathway (for basal cell carcinoma) or epidermal growth factor receptor (for squamous cell carcinoma) has been shown to be effective in preventing disease progression. Patients with eyelid and ocular surface malignancies need to be monitored with careful clinical examination for at least 5years after surgical treatment, and additional investigations may be warranted in some cases.

Non-Invasive Treatment of Extensive Eyelid Cancerous Lesion by Photodynamic Therapy: A Case Report

Cancer of the eyelid represents approximately 10% of all skin cancer in the head and neck region, and approximately 5-10% of all skin cancers. Basal cell carcinoma is the most common cutaneous malignancy in the periocular area, accounting for approximately 70-90% of all cases. The standard treatment for eyelid cancer is surgical excision with reconstruction in case of orbital invasion. Such surgery is involved and in some cases can cause irreversible functional damage to the eye, as well as significant aesthetic and emotional distress for the patient. Photodynamic therapy is a wellestablished technique for the treatment of skin basal cell carcinoma. We therefore propose photodynamic therapy as an alternative treatment of non-melanoma skin cancer and are also indicated as principal option for same types of eyelid cancer. This is a case report of an eighty three year old patient with a histopathological diagnosis of basal cell carcinoma located in the left eyelid. The patient was treated by topical photodynamic therapy using a cream application of 20% Methyl-aminolevulic acid, and a fluency of 150 J/cm2. Clinical evaluation of the patient thirty days after treatment showed a significant clinical response with no evidence of scarring. In addition, no signs of recurrence were observed up to 6 months of follow-up. This clinical case thus showed excellent healing and cosmetic result. In summary, photodynamic therapy is a non-surgical treatment alternative that has the potential to become the number one option for eyelid cancer management, in particular for high risk patients or when surgical resection of highly involved areas is required.

A review of the management options for periorbital basal cell carcinomas

Skin cancer is the most common form of cancer and the incidence of basal cell carcinoma (BCC) is increasing each year ( Cancer Research UK, 2013 ). The incidence of BCC is higher among males, white populations and the older age groups ( Zak-Prelich et al, 2004 ). Anatomically, the head and neck are the most commonly affected sites, attributing to 80% of all reported areas of the body ( Wong et al, 2003 ). According to the British Dermatological Association (BAD) current guidelines ( Telfer, 2008 ), such BCCs are categorised as ‘high risk’ due to their locality and their potential for recurrence. The BAD guidelines propose that the majority of high-risk lesions be treated surgically or by radiotherapy. The eyelids represent a particularly susceptible region for eyelid tumours, and approximately 90% of all eyelid cancers are BCCs ( Baxter et al, 2012 ). Presentation may be diverse; however, it is generally accepted that most BCCs are slow growing, locally invasive, and rarely metastasise, but some variants may be more aggressive. As a form of intervention to remove lesions, surgically there are various options available, namely Mohs micrographic surgery, excision under frozen section control, Slow Mohs and excision with delayed reconstruction. The reconstruction method used by the oculoplastic surgeon will depend on the position and extent of the excised area. This article describes the various treatment options for BCC in more detail, and relates treatment choice to appropriate patient-centred care.

Interstitial brachytherapy for eyelid carcinoma

Eyelid cancer is a therapeutic challenge due to the cosmetic and functional implications of this anatomical region and the objectives of therapy are tumor control, functional and cosmetic outcome. The present study was performed to analyze local control, toxicity, functional and cosmetic results in patients with eyelid carcinoma treated by interstitial brachytherapy. In this study 60 patients with eyelid carcinoma were treated by interstitial brachytherapy using iridium ((192)Ir) wires with a linear activity of 1.2-1.7mCi/cm. The prescription dose was 51-70Gy (mean 65Gy, median 66Gy). Of the 60 patients 51 (85.0 %) had received no prior treatment, 4 (6.7 %) had received previous surgery with positive or close margins and 5 (8.3 %) had suffered local recurrence after surgery. Of the tumors 52 (86.7 %) were basal cell carcinoma, 7 (11.7 %) squamous cell carcinoma and 1 (1.7 %) Merkel cell carcinoma. Clinical stage of the 51 previously untreated tumors was 38 T1N0, 12 T2N0 and 1 T3N0. Mean follow-up was 92 months (range 6-253 months). Local control was maintained in 96.7 % of patients. Late effects higher than grade 2 were observed in 3.0 % of cases. Functional and cosmetic outcomes were optimal in 68.4 % of patients. Interstitial brachytherapy for carcinoma of the eyelid can achieve local control, cosmetic and functional results comparable to those of surgery.

Postoperative interstitial brachytherapy in eyelid cancer: long term results and assessment of Cosmesis After Interstitial Brachytherapy scale.

PurposeTo analyse feasibility and safety of postoperative interstitial brachytherapy (IBRT) in patients of eyelid cancer treated primarily by surgical excision.Material and methodsIn this series, 8 patients with eyelid cancer were treated using postoperative interstitial brachytherapy. Patients were followed up for local control, cosmetic outcome, and acute and late toxicities. Cosmetic outcome was measured using a 6 point indigenous Cosmesis After Interstitial Brachytherapy (CAIB) scale.ResultsThe patients were between 23-82 years (median: 71 years). There were 3 females and 5 males, and 3 patients had lesions in upper eyelid. Postoperative high-dose-rate brachytherapy was used in all with 2 catheters implanted in most of them (6 out of 8). Local control was calculated from end of treatment to last follow-up. At last follow-up, all patients remained locally controlled. Two patients had nodal recurrence 6 months after interstitial brachytherapy and were salvaged effectively by external beam radiotherapy. At last follow-up, 7 patients were loco-regionally controlled and one was lost to follow up. All patients had Radiation Therapy Oncology Group (RTOG) grade 1 acute toxicity and 2 had grade 1 Common Terminology Criteria for Adverse Events (CTCAE) version.3 late toxicities. The cosmesis score for the whole group ranged between 0-1 indicating excellent to very good cosmesis.ConclusionsPostoperative high-dose-rate brachytherapy resulted in excellent disease control and cosmesis without significant acute or late toxicities. It is an effective modality for treatment of eyelid cancers in selected patients. Future prospective studies with the validation of CAIB scale would give us more insight to this effective yet often ignored modality of IBRT.

Xeroderma pigmentosa with ocular association: Case report

Xeroderma pigmentosum is a rare, autosomal recessive disease caused by a defect in DNA repair. Patients with xeroderma pigmentosum often have cutaneous and ocular sun sensitivity, freckle-like skin pigmentation, multiple skin and eye cancers, and, in some patients, progressive neurodegeneration. Xeroderma pigmentosum predominantly affects the ultraviolet (UV) exposed ocular surface, resulting in eyelid atrophy and cancers, corneal dryness, exposure keratopathy, and conjunctival tumors. General features included parental consanguinity (40%), familiarity (60%), onset of symptoms in the first 2 years (50%), malignant skin neoplasms (60%), and carcinoma of the tongue (20%). Among the ocular features, 50% of patients presented with photophobia. Lid freckles or atrophic skin lesions were seen in all patients. Lower lid tumours were seen in 30%, chronic conjunctival congestion in 40%, corneal opacification in 40%, squamous cell carcinoma of limbus in 20%, bilateral pterygium in 40%, and visual impairment in 50%. We report the clinical history and ocular pathology of a boy who is having xeroderma pigmentosum with ocular manifestations. The ophthalmic manifestations of xeroderma pigmentosum are discussed and reviewed with respect to this report and other cases in the literature. These cases illustrate the role of DNA repair in protection of the eyes from UV damage and neuron degeneration of the retina.

A Case of Muir-Torre Syndrome with Multiple Cancers of Bilateral Eyelids and Breast

We report a case of Muir-Torre syndrome (MTS) with a very rare combination of cancers, involving bilateral eyelid cancers and breast cancer. A 71-year-old female with a history of breast cancer from 18 years prior presented with bilateral eyelid tumors. One of her siblings had lung cancer, and another had pancreatic cancer. She underwent excisional biopsy of the eyelid tumors and histopathology revealed sebaceous carcinoma of the right eyelid and basal cell carcinoma of the left. She was diagnosed with MTS: a skin cancer associated with visceral malignancy. Immunohistochemical tests for mutS homolog 2 showed a lack of expression in both eyelid carcinomas.

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Declining incidence of eyelid cancers in Singapore over 13 years: population-based data from 1996 to 2008

PurposeTo describe the epidemiology and trends in eyelid malignancies in Singapore from 1996 to 2008.MethodsThe Singapore Cancer Registry has been collecting epidemiological data of all cancers seen in Singapore since...

The Method of En Face Frozen Section in Clearing Periocular Basal Cell Carcinoma and Squamous Cell Carcinoma

Background: The senior consultants Ross Benger and Andrew Gal have been using en face frozen section histological margin control in removing cancer from the periocular region since 1985. The aim of this study was to determine the percentage of cases in which more than one resection was necessary in order to achieve clear margins.Methods: This is a retrospective study of patients treated at Drummoyne Eye Surgical Centre in the period 1999–2007, in whom removal of the eyelid cancer was decided to be with en face frozen section histological control. A record was kept of how many resections were necessary to achieve clear margins. Paraffin sections were subsequently examined for a final histopathological diagnosis.Results: Two hundred and fifty people were included in the study, of whom 204 had basal cell carcinoma (BCC) and 32 had squamous cell carcinoma (SCC). One hundred and twenty BCCs had a full-thickness eyelid “wedge” resection, of which 45% needed more than the standard two frozen sections taken to achieve clear margins. Eighty-four BCCs were removed using ring resection, of which 35.7% needed more than the standard initial resections (peripheral annulus and deep disc) to achieve clear margins.Conclusions: Our study showed that a significant percentage of BCC and SCC lesions needed further resection after the initial frozen section edge checks to achieve clear margins. Intraoperative presence of the histopathologist increased the likelihood of achieving clearance of the cancer at a single operating session.

Développement de l’appareil Papillon 50™ et de ses applicateurs pour la radiothérapie 50 kV des cancers du rectum et de la peau

ObjectiveContact X-Ray 50kV (CXRT) has proven its efficiency to treat rectum and skin cancers. The goal of this technological research was to design and produce a new CXRT machine with dedicated applicators to replace the Philips unit not any more manufactured. Materials and methodsThe P50 was assembled in UK and the characteristics of the machine were evaluated with spectrometers, ions chambers, Gafchromic films and Monte Carlo code. The applicators were designed and manufactured in Nice. Dosimetric data were measured for each applicator. Validated protocols were used to treat patients. ResultsBetween September 2009 and November 2011, the performances of the P50 was judged satisfactory with a dose rate close to 15Gy/min depending on the applicator. The dose distribution was according to objectives. Clinical results achieved in 62 patients treated in centre Antoine-Lacassagne for rectum, skin or eyelid cancers confirmed the efficiency and good tolerance of CXRT. Similar results in rectal cancer were observed in Clatterbridge with 120 rectal cancers treated with P50. DiscussionThese results are encouraging and should contribute to the international dissemination of CXRT. New machine (Papillon Plus) should be designed and produced for intraoperative irradiation and treatment of vaginal vault. ConclusionThis experience of research and development well structured within the frame of TecSan project should be encouraged further to facilitate technological innovation in the field of radiotherapy.

Sentinel Lymph Node Biopsy in Patients With Conjunctival and Eyelid Cancers

To assess lymph node invasion through the use of sentinel lymph node biopsy (SLNB) in conjunctival and eyelid tumor patients and ascertain the impact of this technique in therapeutic management recommended by the multidisciplinary consensus committee. A single center prospective nonrandomized clinical study was conducted between January 2008 and January 2010. Seventeen patients were included: 4 (2 conjunctiva and 2 eyelid) melanomas, 4 eyelid Merkel cell tumors, 8 (2 conjunctiva, 2 eyelid, 2 eyelid and conjunctiva, 2 cornea and conjunctiva) squamous cell tumors, and 1 eyelid meibomian carcinoma. Preoperative lymphoscintigraphy was done the day before surgery to label lymph node(s). The surgical biopsy was then performed along with an extemporaneous pathological examination followed by secondary complete lymph node dissection only in instances of positive histology. In all cases, one or more sentinel lymph nodes were identified (3-13). Two biopsies (1 Merkel cell carcinoma and 1 squamous cell carcinoma) revealed neoplastic invasion and led to complete cervical node dissection. Adjunct regional treatment was indicated for 1 melanoma, for 4 Merkel cell tumors, and for 2 squamous cell carcinomas. One false negative result was noted in the group of squamous cell carcinomas after 6 months, and it was treated. No relapse or death was observed for the other 16 patients. The mean overall follow-up was 18.2 months. As in previous studies, we found that SLNB for eyelid and conjunctival tumors is safe and effective in identifying microscopically positive SLNs. This procedure may also revive interest in the study of cervicofacial lymphatic drainage. Our current investigation is to be expanded and extended to other medical teams.