Transpalpebral proton beam radiotherapy of choroidal melanoma.

BACKGROUND: Collateral damage to upper eyelid margin during proton beam radiotherapy (PBR) for choroidal melanoma may cause squamous metaplasia of the tarsal conjunctiva with keratinisation, corneal irritation, discomfort and, rarely, corneal perforation. We evaluated transpalpebral PBR as a means of avoiding collateral damage to the upper eyelid margin without increasing the risk of failure of local tumour control. METHODS: Retrospective study of consecutive patients who underwent PBR for choroidal melanoma between 1992 and 2007 at the Royal Liverpool University Hospital and the Douglas Cyclotron at Clatterbridge Cancer Centre, UK. RESULTS: Sixty-three patients were included in this study. Mean basal tumour diameter and tumour thickness were 11.8 mm and 3.6 mm, respectively. PBR mean beam range and modulation were 26.5 mm and 16.9 mm respectively. The eyelid margin was included in the radiation field in 15 (24%) eyes. The median follow-up was 2.5 years. Local tumour recurrence developed in 2 (3.2%) patients. In these two cases that developed tumour recurrence the transpalpebral treatment did not involve the eyelid margin. Six (9.5%) patients died of metastatic disease. No eyelid or ocular surface problems developed in any of the 48 patients who were treated without eyelid rim involvement, while 7 of the 15 patients with unavoidable irradiation of the eyelid rim developed some degree of madarosis. These seven patients all received more than 26.55 proton Gy to the eyelid margin. Symptoms, such as grittiness occurred in 12% of 48 patients without eyelid margin irradiation as compared with 53% of 15 patients whose lid margin was irradiated. CONCLUSIONS: Transpalpebral PBR of choroidal melanoma avoids eyelid and ocular surface complications without increasing failure of local tumour control.

Caracterización clinicoepidemiológica de pacientes con tumores palpebrales malignos / Clinical and epidemiological characterization of patients with malignant eyelid tumors

Se efectuó un estudio observacional, descriptivo y transversal de 61 pacientes con tumores palpebrales malignos, atendidos en la consulta de Oftalmología del Instituto Nacional de Oncología y Radiobiología de Ciudad de La Habana, durante el 2011, a fin de caracterizarles según variables clinicoepidemiológicas de interés para la investigación. En la serie, los más afectados fueron el sexo masculino (68,6 por ciento) y los pacientes de piel blanca (86,9 por ciento); predominaron el grupo etario de 61-70 años (37,0 por ciento), el carcinoma basocelular como el tumor palpebral maligno más frecuente (73,8 por ciento) y la agricultura como la labor fundamental que realizaban los enfermos (67,2 por ciento)

An observational, descriptive and cross-sectional study was conducted in 61 patients with malignant eyelid tumors, treated at the Ophthalmology Department of the National Institute of Oncology and Radiobiology, Havana, during 2011, in order to characterize them according to clinical and epidemiological variates of interest to research. Male sex (68.6 percent) and white patients (86.9 percent) were the most affected in the series. Also, the age group of 61-70 years (37.0 percent), basal cell epithelioma as the most frequent malignant eyelid tumor (73.8 percent) and agriculture as the essential work performed by patients (67.2 percent) prevailed

Ocular risks from sunlight exposure.

Relinquishing the desire to acquire a tan will be difficult for many people. To many individuals, a tan is a symbol of health, fashion and attractiveness. Even when informed about the risks of sunlight exposure, many people ignore the advice to change their behaviors and decrease their risks. Adoption of safe sunlight precautions depends on individual preference, age, work requirements, gender, and perception of personal risk. Many people selectively adhere to certain protective behaviors which do not conflict with social norms. Reinforcement of how sunlight can damage the eyes and skin needs to be continually provided so that public attitudes can adapt to all the necessary appropriate behaviors. Ophthalmic health care professionals have an important part in public education. They can customize their patient's personal protective requirements to match the type of risks uncovered in the clinical work up. The ocular and social history should include the patient's sunlight exposure risk profile and document pre-existing sunlight damage to the eyes and facial areas. All follow-up visits should reinforce sunlight exposure information and document compliance or non-compliance. Only in this way can the eye care delivery system support preventative measures to decrease ocular injuries from sunlight radiation.

Gene transfer of a soluble receptor of VEGF inhibits the growth of experimental eyelid malignant melanoma.

PURPOSE: To determine the effect of adenovirus-mediated gene transfer of a soluble receptor of vascular endothelial growth factor (VEGF) on the growth of experimental eyelid malignant melanoma. METHODS: An adenovirus vector encoding a soluble VEGF receptor/flt-1 (Adflt-ExR) was constructed. The bovine retinal endothelial cells (ECs) were incubated in a culture medium of 293E1 cells infected by means of an adenovirus vector or uninfected (control), which contained human recombinant VEGF, and the [3H]thymidine uptake was tested. The experimental eyelid malignant melanoma was induced by the injection of B16 melanoma cells (4 x 10(6) cells) into the right upper eyelid of BALB/c nu/nu mice, and the size of the tumor was recorded for 3 weeks after tumor cell injection. The effect of Adflt-ExR was examined in three ways. Model 1: B16 cells were infected by Adflt-ExR beforehand (at a multiplicity of infection [MOI] of 10) and injected into the eyelid. Model 2: Adflt-ExR was injected into pre-established B16 cell-induced eyelid malignant melanoma. Model 3: Adflt-ExR was injected into the femoral muscle of mice before B16 cell injection into the eyelid, and the remote effect was evaluated. An adenovirus vector bearing the LacZ gene (AdLacZ) or phosphate-buffered saline was used as a control. The amount of VEGF and the flt-ExR protein was measured by sandwich enzyme-linked immunosorbent assay (ELISA). Vascularization was evaluated by counting the number and the size of the vessels. RESULTS: The supernatant of Adflt-ExR-transfected cells clearly inhibited VEGF-induced bovine retinal EC proliferation in vitro. In models 1 and 2, the tumor growth in Adflt-ExR-treated mice was significantly lower than that of controls (P < 0.05). In model 3, no significant difference was found (P = 0.14). The molar ratio of VEGF/flt-ExR protein was clearly low in the tumors of Adflt-ExR-treated mice in models 1 and 2 (P < 0.01) but not in model 3 (P > 0.05). In vessel density, the tumors in Adflt-ExR-treated mice had fewer vessels than tumors in control animals in models 1 and 2 (P < 0.05). CONCLUSIONS: Adenovirus-mediated gene transfer of a soluble form of VEGF receptor (flt-1) gene inhibited the growth of the experimental eyelid malignant melanoma. This method may be useful as an antiangiogenic therapy for eyelid malignant melanoma.

Frozen section control of excision of eyelid basal cell carcinomas: 8 1/2 years' experience.

For a period of 8 1/2 years all basal cell carcinomas were excised under frozen section control. One hundred and fifty-six patients with 165 tumours were treated, and 137 were followed up for at least three months (3-94 months, mean 29.1 months). There were three possible recurrences, giving a recurrence rate of up to 2.19%. The practical implications, advantages, and difficulties encountered are described, and the place of frozen section control of excision of basal cell carcinoma in a busy NHS general ophthalmic practice is discussed.