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P. B. Johnson, K. Keyhani, M. E. Ashenhurst, J. P. Arlette; Treatment of Periocular Cutaneous Malignancies. Invest. Ophthalmol. Vis. Sci. 2007;48(13):5248.
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Periocular cutaneous malignancies present a challenge in terms of diagnosis and appropriate management. The goal of therapy is to preserve ocular function as well as maintaining an aesthetic appearance. Treatment requires complete extirpation of the involved disease area as well as conserving maximal amount of tissue.
A retrospective chart analysis was carried out of all cutaneous malignancies within the periocular surface treated by Mohs Micrographic surgery over a 12 year time period. More than 600 cases were identified, with one identified recurrence, and three non-resectable lesions. The type of cancers included basal cell carcinoma, squamous cell carcinoma, squamous cell carinoma in situ, malignant melanoma and sebaceous carcinoma. The relationship of disease location, type of malignancy, gender distribution, and amount of tissue removed will be discussed in light of the anatomical sequelae of disease within the periocular surface.
Fifty-four percent of malignancies involved the left eye, 46% involved the right. The lower eyelid was involved in 46.5%, the medical canthus in 37.0%, the lateral canthus in 11.6%, and the upper eyelid in 6.6%. Primary lesions comprised 79.5% of the sample; recurrent lesions comprised 19.9%. Malignancies included nodular basal cell carcinoma (52.6%), infiltrative basal cell carcinoma (29.2%), superficial basal cell carcinoma in (6.9%), squamous cell carcinoma in situ (3.8%), invasive squamous cell carcinoma (3.8%), sebaceous cell carcinoma (2.0%), malignant melanoma in situ (2.1%), and invasive malignant melanoma (0.6%). The incidence of squamous cell carcinoma was 5.6% in males and 1.8% in females. Males comprised 72.5% of lateral canthal tumors; females comprised 27.5%. Females comprised 56.3% of medial canthal tumors; males comprised 43.8%.
Cutaneous malignancies occur frequently within the periocular area. Mohs micrographic surgery offers a high cure rate with maximal tissue preservation. Males showed a higher incidence of squamous cell carcinoma in our patient population. In malignancies involving the canthi, the lateral canthus was more frequently involved in males while the medial canthus was more frequently involved in females.
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