Diagnosis and treatment of malignant eyelid tumors.

BACKGROUND: Malignant tumors of the eyelid are much less frequent than benign eyelid alterations. These are frequently incidental findings without symptoms which are often overlooked or misinterpreted by patients. OBJECTIVE: This article gives an overview of clinical aspects, diagnostics and treatment of the five most common malignant eyelid tumors and exemplarily explains the essential principles of evidence-based treatment of malignant eyelid tumors. METHODS: This narrative review was prepared based on a selective literature search. The depiction of the treatment of eyelid tumors is supported by illustrations of clinical cases. RESULTS: The medical history and inspection provide initial indications of malignancy. Every eyelid change suspected of being malignant should be examined histologically to confirm a diagnosis. By far the most common malignant eyelid tumor in Europe is basal cell carcinoma, which metastasizes only in exceptional cases. Squamous cell carcinomas, sebaceous adenocarcinomas, melanomas and Merkel cell carcinomas occur much less frequently. In these cases, potential metastasis in particular must be considered when making the diagnosis and staging has to be initiated. Surgical excision into healthy tissue with tumor-free margins is the gold standard for malignant eyelid tumors. Non-surgical adjuvant or neoadjuvant forms of evidence-based treatment can be initiated based on the individual case to minimize the risk of recurrence and metastasis. CONCLUSION: It is essential to recognize eyelid changes at an early stage, to classify them correctly and to initiate the appropriate treatment. The interaction between the general condition and the personal needs of a patient as well as state of the art medicine are the keys to a good personalized treatment.

[Diagnosis and treatment of malignant eyelid tumors]. / Diagnose und Therapie der malignen Lidtumoren.

BACKGROUND: Malignant tumors of the eyelid are much less frequent than benign eyelid alterations. These are frequently incidental findings without symptoms which are often overlooked or misinterpreted by patients. OBJECTIVE: This article gives an overview of clinical aspects, diagnostics and treatment of the five most common malignant eyelid tumors and exemplarily explains the essential principles of evidence-based treatment of malignant eyelid tumors. METHODS: This narrative review was prepared based on a selective literature search. The depiction of the treatment of eyelid tumors is supported by illustrations of clinical cases. RESULTS: The medical history and inspection provide initial indications of malignancy. Every eyelid change suspected of being malignant should be examined histologically to confirm a diagnosis. By far the most common malignant eyelid tumor in Europe is basal cell carcinoma, which metastasizes only in exceptional cases. Squamous cell carcinomas, sebaceous adenocarcinomas, melanomas and Merkel cell carcinomas occur much less frequently. In these cases, potential metastasis in particular must be considered when making the diagnosis and staging has to be initiated. Surgical excision into healthy tissue with tumor-free margins is the gold standard for malignant eyelid tumors. Non-surgical adjuvant or neoadjuvant forms of evidence-based treatment can be initiated based on the individual case to minimize the risk of recurrence and metastasis. CONCLUSION: It is essential to recognize eyelid changes at an early stage, to classify them correctly and to initiate the appropriate treatment. The interaction between the general condition and the personal needs of a patient as well as state of the art medicine are the keys to a good personalized treatment.

[Diagnosis and treatment of benign eyelid tumors]. / Diagnose und Therapie der benignen Lidtumoren.

BACKGROUND: Benign tumors of the eyelids are frequent entities. They are often cause for cosmetic concern or can lead to irritation of the ocular surface. The differentiation from premalignant or malignant eyelid tumors is particularly important. In most cases this can be done clinically; however, in some cases histological evaluation is warranted. OBJECTIVE: The aim of this article is to characterize the most important benign tumors of the eyelid and to ascertain when a histological examination is necessary. Furthermore, fundamental treatment procedures are discussed. METHODS: This narrative review was prepared based on a selective literature search. The characteristics of some eyelid tumors are underlined with illustrations from clinical cases. RESULTS: Most benign eyelid tumors are treated because of cosmetic or functional concerns. Some of them, including actinic keratosis, keratoacanthoma, cutaneous horn, trichofolliculoma, resemble malignant lid tumors or precancerous lesions and are thus excised in oder to obtain a diagnosis. Dermoid cysts can cause complications and congenital melanocytic naevi can exhibit malignant transformation and may need treatment. Inflammatory tumors can be treated conservatively in most cases but might require surgery in certain cases. Systemic associations exist with some of the benign lid tumors and should not be overlooked as they can be crucial for overall patient morbidity. CONCLUSION: Benign tumors of the eyelids are frequent and can be found at any age depending on the diagnosis. This article describes the lesions most commonly encountered in the clinical routine and helps at making a plan for further management.

[Surgical treatment of eyelid tumors]. / Operative Therapie von Lidtumoren.

Eyelid tumors are often periocular skin lesions but can also be derived from adnexal structures or the conjunctiva. Treatment is primarily surgical, especially for malignant tumors, whereby complete excision is strived for to minimize the local rate of recurrence. Adjuvant therapy and conservative alternative methods (e.g. radiotherapy, cryotherapy and immunomodulation) are reserved for specific cases. The main goal for reconstruction of the eyelids is the functional and aesthetic rehabilitation. This article focuses on the principles and underlying techniques for the reconstruction of the periocular region.

[Oculoplastics in Cameroon]. / Okuloplastische Kurzzeitdozentur in Kamerun.

Ophthalmological care in Cameroon is still being developed, although surgery for cataract and glaucoma is well established in several centres across the country. Our objective was to train the local doctors of the Presbyterian Eye Hospital (Acha) in Bafoussam and Douala to perform the most common oculoplasty procedures. The German Ophthalmological Society funded the project with a short-term lectureship of 2 weeks. We now present the results of the first two visits to Acha. We saw 96 oculoplastic patients and performed 44 surgeries. Most of the cases were nasolacrimal duct obstructions, cicatricial ectropion and lagophthalmos following trauma, as well as socket deformities. We were able to perform lid and socket reconstructions as well as dacryocystorhinostomies and other oculoplastic interventions. During the second visit, we had the opportunity to perform general anaesthesia and were able to tackle some of the initial challenges for oculoplastic surgery. The acquisition of instruments and materials are ongoing and training of the local doctors has just started after an analysis of the cases presenting in this particular setup.

[Intravitreal administration of triamcinolone and bevacizumab for pigment epithelial detachment in conjunction with AMD]. / Intravitreales Triamcinolon und Bevacizumab bei Pigmentepithelabhebung im Rahmen der AMD.

BACKGROUND: The effect of the vascular endothelial growth factor (VEGF) inhibitors triamcinolone and bevacizumab (Avastin) on serous pigment epithelial detachment (PED) related to age-dependent macular degeneration (AMD) was analysed retrospectively. PATIENTS AND METHODS: Data of 45 patients (45 eyes) were evaluated: 11 patients received an intravitreal injection with triamcinolone and 16 with bevacizumab. The remaining 18 patients received no therapy. Visual acuity (VA), height of the PED, retinal thickness and the cystoid component of the PED were compared after 6 months follow-up. RESULTS: Over 90% showed a stabilisation or improvement in VA after bevacizumab therapy; 63% of those who received triamcinolone showed VA stabilisation. Patients who received no therapy had a significant decrease in VA. CONCLUSIONS: Our data seem to implicate that VA outcome is much better after bevacizumab treatment. VA outcome seems to correlate with the cystoid component of the foveal oedema rather than with the height of PED. A greater number of patients with a longer period of follow-up are necessary to confirm these results.