Basal Cell Carcinoma Of Lower Eyelid Research Articles

Case Report of Lower Eyelid Basal Cell Carcinoma

Basal cell carcinoma is the most common skin cancer in humans and is frequently found in the periocular region. It is the mostcommon type of eyelid cancer, generally characterized by slow growth with rare metastasis and has an excellent prognosis withcurrent surgical techniques. This is a case report of left lower eyelid basal cell carcinoma for which surgical excision with eyelid reconstruction was performed. Histopathological examination of resected mass was consistent with nodulo-ulcerative basal cell carcinoma.Early diagnosis and management of suspicious lesions is important to ensure the clinical result.

All-in-One Lower Eyelid Reconstruction after Skin Malignancies Removal: Combined Modified Tenzel Flap & Palatal Mucosal Graft

Lower eyelid reconstruction for defects greater than 50% is a much discussed topic in literature. The aim of this paper is to present an “all-in-one” surgical technique based on the combination of modified Tenzel flap and palatal mucosal graft to restore the anatomical integrity. In our paper we present a case report of 64 years old patient admitted in Maxillo-Facial Surgery Unit of Polyclinic Federico II of Naples in January 2020. He was affected by lower eyelid basal cell carcinoma, measuring 1.5 cm in diameter. He was treated removing full-thickness neoplasia, leaving a surgical gap of 2 cm. Reconstruction was performed using modified Tenzel flap to cover the skin gap and a palatal graft for the reconstruction of the tarsal region structural integrity. This "all-in-one" technique can handle full thickness eyelid defects with the advantage of respecting the dual layer eyelid structure without the need of a secondary surgical step. Moreover, has shown excellent results for both the preservation of eyelid competency and the low complications rate like ectropion and lagophthalmos.

Submental and Anterior Neck Originated Full-Thickness Skin Grafts for Periocular Procedures.

The submental and neck regions share cutaneous features with the face and are suitable donor sites for facial full-thickness skin grafts (FTSGs). Age-related laxity and skin redundancy in the cervicomental region may be an additional motivator to use its skin. We aim to describe, raise awareness, and remind surgeons of the utilization of submental and anterior neck as sources of FTSG for the periocular region, particularly when traditional donor sites are unavailable. Retrospective case series of 5 patients who underwent periocular FTSG from anterior neck and submental regions between January 2017 and January 2019. All patients had contraindications to the usually preferred graft donor sites. Main outcome measures were surgical functional results and cosmesis. Five patients (all female) received FTSGs using anterior neck and submental regions as donor sites. Two patients required skin grafts due to eyelid retraction and anterior lamella shortening; one due to previous multiple basal cell carcinoma excisions with FTSG reconstructions and the other due to chronic Bell's palsy. Three patients required skin grafts for Hughes flap reconstruction after excision of lower eyelid basal cell carcinoma. In all patients, conventional skin donor sites were unavailable or unsuitable due to previous skin grafting, actinic changes, postauricular situated hearing aids or patient's preference. All patients achieved good cosmesis and functional results. None of the patients experienced donor site morbidities. Submental and anterior neck regions are useful FTSG donor sites for periocular procedures, particularly in elderly female patients with submental fullness and neck skin redundancy.

Lower eyelid reconstruction with pericranium graft and Mustarde flap

We report the case of a 68-year-old man with a left lower eyelid basal cell carcinoma with squamous differentiation. Resection was performed under frozen section technique and the defect (inner canthus, two thirds of the lower eyelid and 2.5cm of the cheek) reconstructed 2 days after surgery in a single surgical operation: posterior lamella with pericranial graft and anterior lamella with Mustarde flap. After one year of follow-up, the patient has an adequate appearance, good eyelid support and position, vascularized tissue like the native eyelid and no tumor recurrence.

Reconstrucción de párpado inferior mediante injerto de pericráneo y colgajo de Mustardé

We report the case of a 68-year-old man with a left lower eyelid basal cell carcinoma with squamous differentiation. Resection was performed under frozen section technique and the defect (inner canthus, two thirds of the lower eyelid and 2.5cm of the cheek) reconstructed 2 days after surgery in a single surgical operation: posterior lamella with pericranial graft and anterior lamella with Mustarde flap. After one year of follow-up, the patient has an adequate appearance, good eyelid support and position, vascularized tissue like the native eyelid and no tumor recurrence.

Excision of nodular basal cell carcinoma involving the lower eyelid tarsal skin using a grey line-splitting, posterior lamella-sparing technique

ABSTRACT Purpose: To describe a posterior lamella-sparing technique to resect nodular basal cell carcinoma involving the inferior part of the tarsal skin of the lower eyelid. Surgical Technique: Excision of nodular basal cell carcinoma of the tarsal skin using a grey-line-splitting technique with preservation of the posterior lamella. Specimen was sent for frozen section control. Additional excision was performed in caseof irradicality. The defect was closed with a free skin graft from the ipsi- or contralateral upper eyelid. Results: We show a case series of three patients with lower eyelid basal cell carcinoma and investigated radicality on histology, aesthetic outcome and clinical recurrence during a follow-up of 18 months. Pre, intra, and postoperative photographs were obtained. In all cases radicality was reached. In all patients, the skin graft was viable, with no recurrence after 18 months. Excellent aesthetic results were obtained. Conclusion: Anterior lamellar resection of nodular basal cell carcinomas involving the tarsal lower eyelid skin using a grey line lid-splitting technique is a simple and one-step technique with good clinical outcome. It may avoid the morbidity associated with full thickness eyelid resection and might be useful for other, nonmalignant eyelid lesions.

Treatment of eyelid basal cell carcinoma with Mohs micrographic surgery

Objective To investigate the efficacy of Mohs micrographic surgery in the treatment of eyelid basal cell carcinoma. Methods The data of 12 cases with lower eyelid basal cell carcinoma were collected and retrospectively analyzed. All cases underwent Mohs micrographic surgery combined with one stage repair of eyelid defect. The repair methods included sliding, rotation flap, free skin graft and upper eyelid tarsal conjunctival flap repaired surgery. Postoperative eyelid shape, function and tumor recurrence were observed 6 months-3 years after surgery. Results After surgery the skin incision of 9 cases retained tarsus intraoperatively was good.The sliding flap, rotation flap and free skin graft were all survived.Among them 2 cases of rotation flap were in the form of mild elevation in early time, they became flat and level 3 months afer surgery.The color of free skin graft appeared light firstly, then became pigmentation deposit, it gradually returned to normal 6 months later. The tarsals were rosy and survived well after 3 months in 3 cases of full-thickness eyelid underwent resection. All the patients achieved satisfied appearance of the eyelids, the wound was healed, conjunctiva and cornea were not exposed. No recurrence occurred. Conclusion Mohs micrographic surgery combined with the reconstruction of eyelid is effective and safe for the treatment of eyelid basal cell carcinoma. Key words: Basal cell carcinoma, eyelid; Mohs micrographic surgery

Histopathological changes in involutional lower eyelid entropion: the tarsus is thickened!

ObjectiveEvaluation of histopathological changes in lower eyelid involutional entropion. DesignCase–control, comparative study at a single institution. ParticipantsA total of 20 consecutive patients with previously untreated involutional lower eyelid entropion and 20 matching patients with lateral lower eyelid basal cell carcinoma (BCC). MethodsPatients with involutional entropion were operated using our modified surgical method, and patients with BCC underwent full-thickness pentagonal excision with 3-mm surgical margins. Histopathological analysis of the full-thickness eyelid specimens of both groups included measurements of tarsal thickness and height, thickness of the pretarsal orbicularis oculi muscle, diameter of muscle fibres, and qualitative changes in lower eyelid retractor attachment. ResultsThe tarsus was significantly thicker in the entropion group (p = 0.006). The mean tarsal thickness was 1.40 ± 0.32 mm, whereas in the BCC group it was 1.16 ± 0.19 mm. There was no statistically significant difference in the tarsal height and the thickness of the pretarsal orbicularis oculi muscle between the 2 groups. In the entropion group, 60% of the lids had total and 35% partial dehiscence of the retractor, whereas in the BCC group, dehiscence was found in only 45% of the lids. The difference was statistically significant (p = 0.002). ConclusionsTo the best of our knowledge, this is the first histopathological study documenting thickening of the tarsus in involutional lower eyelid entropion. Moreover, dehiscence of the lower eyelid retractor was proven histopathologically in 95% of the entropic lids. With this in mind, correction of vertical instability should be mandatory in involutional lower eyelid entropion repair.

眼睑基底细胞癌切除联合硬腭粘膜移植及带蒂皮瓣移位眼睑重建术的护理

目的：总结20例下眼睑大面积基底细胞癌切除硬腭粘膜移植联合颞部或额部带蒂皮瓣移位眼睑重建术的护理体会。方法：运用优质护理针对患者心理、术前、术后负压吸引、口腔、体位、皮肤等问题采取相应的护理措施。结果：20例患者术后皮瓣均成活，供皮区未发生感染及形成继发性缺损。再造眼睑全部成活，无畸形、功能良好。随访6个月~4年肿瘤均无复发。结论：全方位的优质护理，细致入微的密切观察是提高手术治愈率和患者满意度的关键。 Objective: To summarize the nursing experience of 20 cases of lower eyelid basal cell carcinoma patients, whose carcinoma was cut off and transplanted the hard palate mucosa graft combined with eyelid reconstruction using of temporal or frontal pedicle flap. Method: Using quality care protocol, according to the patients’ psychological problems, pre- and postoperative negative pres- sure suction, oral, posture, skin and other issues to take appropriate nursing measures. Result: The graft flaps of the 20 patients were all survived. No infections were found in the donor sites and no secondary defects were formed. The eyelids were all survived with no deformity, and the function was well without malformation. There was no tumor recurrence in 6 months to 4 years of follow-up after operation. Conclusion: A full range of high quality nursing and careful observation is the key to improve the cure rate and the patients’ satisfaction.

Skin Graft Hypertrichosis Associated With Prostaglandin Analog in the Treatment of Glaucoma

Prostaglandin analogs are commonly used in the treatment of glaucoma. They are a safe and effective treatment associated with few side effects. Common local side effects include conjunctival hyperemia, iris pigmentation, and eyelash hypertrichosis. The authors present a case of a patient using travoprost treatment for primary open-angle glaucoma, who underwent excision of a lower eyelid basal cell carcinoma and reconstruction with an upper eyelid tarsoconjunctival flap and overlying skin graft. The patient developed hypertrichosis of the skin graft attributable to prostaglandin analog use.

The application of axial superficial temporal artery island flap for repairing the defect secondary to the removal of the lower eyelid basal cell carcinoma

Our aim was to investigate the repair of the defect that follows excision of a basal cell carcinoma (BCC) of the lower eyelid. Skin projections of the superficial temporal artery and its frontal branches were marked using Doppler ultrasonography. The lesion was excised with 0.5–1.5cm margins. Frozen sections were taken to clarify the diagnosis. The frontal flap was designed according to the preoperative labelling, and was 0.5cm larger than the defect. The pedicle was 1.0–1.5cm longer than the distance between the pedicle and the defect, and the width of the pedicle was 3cm. If the lesion affected the full thickness of the lower eyelid, a conjunctival flap was sutured with the flap. A skin graft was applied when the defect was large. Such defects have been repaired successfully in 10 patients. There was no secondary defect or ectropion postoperatively. The superficial temporal artery frontal branch island flap is a satisfactory method for the repair of a defect secondary to a BCC of the lower eyelid.

Using Bipedicled Myocutaneous Tripier Flap to Correct Ectropion After Excision of Lower Eyelid Basal Cell Carcinoma

Many techniques have been described for correcting ectropion, but when the ectropion follows skin cancer excision, only a technique that replaces missing skin should be used. The bipedicled Tripier flap tends to give some excess bulk at each end but gives an excellent correction of ectropion. The aim of this study was to apply musculocutaneous bipedicled Tripier flap from upper lid for correction of ectropion due to previous excision of lower-lid malignancies and evaluate its outcome. This was a prospective case-series study. In this study, 15 patients (6 women, 9 men), ranging from 35 to 72 years old (mean, 51 years) underwent operation with Tripier flap for reconstruction of ectropion because of basal cell carcinoma (BCC) resection. In patients with ectropion, Tripier flap with or without ear or nasal septal cartilage was used for reconstruction of deformities 3 months after lower-lid reconstruction with local flaps. All patients were satisfied, and ectropion was corrected in all cases. There were no complications such as dry eye or corneal abrasion after operation. Also, we had not any case of ischemic flap. We suggest that Tripier flap is one of the best methods for reconstruction of lower-lid retraction or ectropion. This is a desirable method, functionally and aesthetically.

Recurrent sebaceous gland carcinoma of eyelid previously diagnosed as basal cell carcinoma: case report

Sebaceous gland carcinoma (SGC) of the eyelid is a highly malignant neoplasm that arises from the meibomian glands, glands of Zeis, and sebaceous glands of the skin. The characteristics of this disease are high recurrence rate, significant metastatic potential, and notable mortality rate, which are quite different from basal cell carcinoma (BCC). We report the case of a 37-year-old woman with the history of left lower eyelid BCC (diagnosed 9 years ago), who had left parotid lymph nodes metastases and local recurrence twice. The chief complaint during visit was a left upper eyelid swelling mass noted for 3 months. She received salvage ablation surgery later. The final pathologic report is SGC. The diagnosis corresponds to the clinical presentation of this patient at last. The delay between initial examination and final diagnosis in this patient is about 9 years, but operation and concurrent chemotherapy and radiotherapy were performed after left parotid lymph nodes metastasis was noted. Although there was still local recurrence after concurrent chemotherapy and radiotherapy, the patient is still alive without distant metastasis. In this article, we would discuss the differences of the pathologic characters, treatment, and prognosis between SGC and BCC.

Photodynamic therapy of eyelid basal cell carcinoma

Photodynamic therapy (PDT; i.e. selective destroying of malignant cells by exposing them to red light after photosensitization) has been increasingly used for non-melanoma skin cancers. Due to excellent cosmetic and functional results, especially in difficult-to-treat areas, it may offer a comprehensive alternative to previous treatment modalities. A series of six patient cases was used to evaluate the efficacy of PDT in the treatment of lower eyelid basal cell carcinoma (BCC). Methods Histological confirmation of BCC, a detailed demonstration of the technique with an illustrative series of cases and a review of related literature. Six patients with lower eyelid BCC were treated with two treatment sessions of PDT within a week. Five patients had a nodular type and one patient had a superficial type of BCC. The follow-up after treatment continued for 20-36 (mean 26.5) months. No recurrences were observed during the follow-up. All the patients were satisfied with the good results and tolerated the treatment well without any harm to the eyeball or surrounding skin. PDT, although experimental in the eyelid area because of the small amount of data and the lack of a long-term follow-up, may be considered a promising comprehensive alternative when treating BCC in the eyelid area.

Application of superficial temporal artery frontal branch island flap for repair of defect secondary to lower eyelid basal cell carcinoma

目的 探讨下睑基底细胞癌的治疗方法.方法 术前用超声多普勒测定并标记颞浅动脉及其额支的走行方向.术中距病损边缘0.5～1.0 cm切除病变组织,并送冰冻切片检查,以确定病变的性质及是否切除彻底.据术前标记设计额部皮瓣,皮瓣应大于缺损0.5 cm,蒂长大于蒂到缺损区1.0～1.5 cm,宽约3 cm.累及眼睑全层的缺损,将结膜游离后上拉与皮瓣缝合,或将皮瓣设计足够大,将皮瓣边缘修成全厚皮,翻转后与结膜缝合.供区创面较大,可考虑皮片移植修复.结果 本组5例,均行额部岛状皮瓣修复,术后无下睑缺损及外翻.结论 应用颞浅动脉额支岛状皮瓣修复下睑基底细胞癌切除后创面,效果良好。