A 5-year review of 1220 malignant periocular tumours in an English county.

BACKGROUND/OBJECTIVES: To determine the incidence, proportion and location of periocular tumours in an English county over a five year period, and compare to other studies in the UK and worldwide. SUBJECTS/METHODS: A retrospective review of histopathology reports was performed for all periocular excision biopsies of malignancies from the county's three main hospitals over a 5-year period. These hospitals cover a population of just over one million. Tumours were classified according to type and location. RESULTS: 1220 lesions were included in this study. Right-sided lesions were more common than left. The incidence of basal cell carcinoma was 22 per 100,000 and squamous cell carcinoma 1.3 per 100,000, which were found most commonly on the lower eyelid and eyebrow respectively. The incidences of all other types of lesions were less than 0.5 per 100,000 per year. CONCLUSIONS: The incidence of periocular basal cell carcinomas in the predominantly elderly Caucasian population was at least three times the published national average. The high incidence of periocular tumours in this North East Anglian county is set to increase further as the proportion of over 65 year olds in the population is predicted to nearly double within two decades.

A multicentre review of the histology of 1012 periocular basal cell carcinomas.

AIMS: To evaluate primary periocular basal cell carcinomas (BCCs) in depth including comparing histological margins with subtype, location and surgical specialty after wide local excision. METHODS: A retrospective review was performed for all BCCs excised from three hospitals over 5 years, covering a population of just over 1 million. Tumours were classified according to histological subtype location. Incomplete excision rates and margins were analysed in detail and comparisons made. RESULTS: The most common subtype found was nodular followed by infiltrative. Lesions were most commonly located at the lower lid. Infiltrative BCCs were associated with perineural invasion and incomplete excision despite the largest peripheral margins. Superficial BCCs had the smallest mean peripheral margin but the largest mean deep margin. 2 mm histological margins gave an 83.7% complete excision rate, 6.4% incomplete excision rate and 7.1% where the clearance margin was 0.3 mm or less. CONCLUSION: Distribution of eyelid BCCs based on subtype and periocular location mirrored the general consensus. Infiltrative BCCs should be excised with wider margins or referred for Mohs surgery, especially if the medial canthus is involved. Superficial BCCs should be excised with wider but shallower surgical margins. Ophthalmologists were more likely than dermatologists or plastic surgeons to incompletely excise a periocular BCC, which is reflective of their more difficult case mix.

Lacrimal sac primary squamous cell carcinoma with synchronous tonsillar primary squamous cell carcinoma.

A gentleman with recurrent epiphora after two failed endonasal dacryocystorhinostomies was found to have a squamous cell carcinoma of the lacrimal sac at his third operation via an external approach. CT showed contralateral nodal involvement; however, biopsy of the node found it to be histologically distinct from the lacrimal sac lesion. A PET-CT revealed a second primary lesion located at the contralateral palatine tonsil. We discuss the histological features of squamous cell carcinomas and the impact on prognosis. This case highlights the importance of nasoendoscopy prior to lacrimal surgery. There should be a low threshold for lacrimal sac biopsy, and any anatomical or histological inconsistency should prompt further investigation.

Periocular photodynamic therapy for squamous intra-epidermal carcinoma.

OBJECTIVES: To evaluate the response of Metvix photodynamic therapy (PDT) for the treatment of periocular Bowen's disease. METHODS: Four patients with biopsy-proven Bowen' disease were treated with Metvix PDT between November 2010 and January 2012. A detailed description of the technique used is described. RESULTS: All of the patients tolerated the PDT well. All had some clinical response to the treatment, although there was not complete, lasting resolution beyond one year in three out of the four cases. CONCLUSION: PDT can be a good treatment in its own right in selected cases of periocular Bowen's disease.

The Tie retraction syndrome.

Tissue retraction is implicated in the pathogenesis of various ophthalmic disorders. Here we describe the clinical characteristics, epidemiology and pathophysiology of a form of retraction syndrome which - to the best of our knowledge - has not been reported in the ophthalmic literature so far. We have termed this condition - consisting of a slowly progressive pseudovertical shortening of tie length due to a horizontal extension of girth length - the "Tie retraction syndrome" (TRS). Other pathognomonic features include an increased tie tip to belt buckle distance and a prolapse of the subumbilical fat pad (SUFP). The syndrome has a clear male to female preponderance and shows an increasing incidence with age and income before tax. Based on a newly proposed grading scheme we discuss and illustrate the diagnosis as well as the medical and surgical management options of this abundant, but often undiagnosed condition. The authors have no explanation for the apparent lack of awareness for this widely preponderant syndrome and its severe cosmetically disfiguring potential. We thus would like to invite all fellow colleagues with expertise in the field to comment or present their views.

Systemic T-cell lymphoma presenting as an acute nonresolving eyelid mass.

A healthy 39-year-old man was referred with a 3-week history of nonresolving right upper eyelid cyst with no globe or orbital involvement. Histopathologic examination revealed a peripheral T-cell lymphoma of unspecified type, which was stage 3 on staging. He received combination cyclophosphamide, hydroxydoxorubicin, oncovin, and prednisolone therapy with an autologous bone marrow transplant and remains in complete remission 24 months posttreatment. A brief literature review of ocular adnexal T-cell lymphomas is presented.