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R. J. Peralta, D. M. Albert; Lesions of the Canthus: A Clinical and Histopathologic Review of 187 Cases. Invest. Ophthalmol. Vis. Sci. 2010;51(13):4284.
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Previous studies characterized the epidemiologic and histopathologic features of lesions of the eyelid and adnexa. Few have focused specifically on lesions of the canthus. Our research hopes to expand on this knowledge base and aid in the clinical and surgical management of these lesions.
Retrospective review of 190 consecutive cases of lesions of the canthus analyzed at the University of Wisconsin between 2003 and 2009. Information on patient demographics, lesion location, clinical and histopathologic diagnosis was obtained from medical records.
190 cases were identified, 3 were excluded for incomplete data, and 187 were considered for analysis. Average age was 59.1 (±16.8) years. Women (111, 58.5%) were more likely to undergo excision than men (79, 41.5%). The right and left eyes were affected equally (50.3% and 49.7%, respectively). The medial canthus (114, 61.0%) was more frequently involved than the lateral canthus (73, 39.0%).87.8% (167) of the lesions were benign, 10.6% (20) malignant and 1.6% (3) premalignant. The average age was 57.5 (±17.1) and 68.5 (±11.3) years for patients with benign and malignant lesions, respectively. This difference was statistically significant (p=0.005). The distribution of benign and malignant lesions amongst the medial and lateral canthi were similar (60.8 and 60.0% medially, 39.2 and 40.0% laterally, respectively).More than 23 histopathologic diagnoses were made. Overall, the most common was benign epithelial proliferation (seborrheic keratosis and squamous papilloma), accounting for 25.5% (48) of the cases, followed by hidrocystoma (20.2%, 38), epidermoid/epithelial inclusion cyst (18.1%, 34), basal cell carcinoma (9.6%, 18), nevus (6.9%, 13) and dermoid cyst (2.1%, 4). Basal cell carcinoma was by far the most common malignant lesion (90%). One case of sebaceous carcinoma and unspecified carcinoma were reported. No cases of squamous cell carcinoma were seen.A clinical diagnosis was provided in 138 (73.0%) cases and correlated with the histopathologic diagnosis 78.3% of the time. Separately, similar rates were seen for benign (78.6%) and malignant (75.0%) lesions.
The majority of lesions of the canthus are benign, most commonly epithelial proliferations or cysts. They are more frequent in women and at the medial canthus. Benign and malignant lesions are distributed similarly amongst the medial and lateral canthi. Malignant lesions, overwhelmingly basal cell carcinomas, are more common in older patients. Given the broad spectrum of lesions presenting at the canthus, excisional biopsy with histopathologic analysis is warranted, especially in the elderly.
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