Technicians & Nurses Program
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1 ASCRS ASOA Symposium & Congress Technicians & Nurses Program May 6-10, 2016 New Orleans
2 Evaluation and Treatment of Eyelid Malignancies Richard C. Allen MD PhD FACS Professor Section of Ophthalmology Dept. of Head and Neck Surgery University of Texas MD Anderson Cancer Center Houston, TX Goal Identify malignancy early Before any significant spread occurs JCAHPO Technician and Nurses Program Sunday May 8, :15-3:15 pm New Orleans, LA Financial Disclosure None Patient evaluation History Exam I do not have a financial interest associated with anything discussed in this talk Benign Growth is confined Likelihood of morbidity or mortality is low Malignant Growth results in spread Adjacent spread Regional spread Distant spread (metastasis) Potential for morbidity and mortality History How long has it been there? Does it hurt? Has it changed?
3 Cutaneous Carcinomas Previous medical history Previous skin cancers? Immunocompromised? Radiation? Ulceration Painless Induration Irregular borders Telangiectasia Pearly borders Loss of eyelid structures Asymmetric growth Color change Multiple colors Recent change Patient aware Social history Significant sun exposure Smoking Characteristics of malignancy Tissue destruction Lash loss Ulceration Loss of lid architecture Family history Others with skin cancers Especially early in life
4 Basal cell carcinoma Most common eyelid malignancy best malignancy to have Spread to adjacent tissue Fair complexion, light or red hair, UV exposure Clinical characteristics Lower lid and medial canthus Watch for the tear duct Ulceration pearly Telangiectasias Little blood vessels Types of eyelid malignancies Basal cell carcinoma Squamous cell carcinoma Sebaceous cell carcinoma Melanoma Merkel cell carcinoma
5 Mohs surgery Performed by the dermatologist Usually Mohs on one day followed by reconstruction the next day Best chance to remove the entire tumor Spare healthy skin Frozen section evaluation Done in the OR Sent to the pathologist One setting Maybe not as effective as a Mohs Treatment Complete excision Mohs surgery Frozen section Squamous cell carcinoma Second most common UV exposure, immunocompromised Spread is adjacent, but also along nerves Perineural spread This is how a skin cancer can go from you eyelid to your brain
6 Clinical characteristics Produces keratin Scaly Precursor Actinic keratosis Treatment Complete surgical excision Mohs Frozen section Sebaceous carcinoma great masquerader Regional spread Lymph nodes Clinical characteristics Recurrent chalazion Chronic unilateral conjunctivitis
7 Treatment Complete surgical excision Permanent section Lymph node evaluation Metastatic work-up Permanent section evaluation Excise on one day, pathologist looks at it the next day Repair 2-3 days after resection as long as margins are clear Melanoma Less than 1% of eyelid tumors Has pigment Risk of distant spread Lungs Liver Precursor Lentigo maligna
8 Clinical characteristics Pigment ABCs Asymmetry Border Color Treatment Complete surgical excision Permanent section Lymph node evaluation Metastatic work-up Merkel cell carcinoma Rare tumor Risk for regional spread Clinical appearance Fast growing Vascular appearance
9 Treatment Surgical excision Permanent section Lymph node evaluation Consider radiation Quick quiz! Benign or malignant?
10 We treat skin cancer today like the surgeon 100 years ago treated infection. This will change and is changing.
11 Eyelid reconstruction Reconstruct the back layer and front layer separately Use flaps or free tissue transfer Flaps Move adjacent tissue into the defect Free tissue transfer Cut out a piece of tissue from one area and transfer it to your defect Skin, mucous membrane, tarsus, etc. Full Thickness Skin Donor Sites Eyelid Lamellae Anterior Lamella Skin Muscle Posterior Lamella Tarsus Conjunctiva
12 Wedge resection Skin graft
13 Glabellar flap
14
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16 Remember The goal is to identify malignancy early If you don t know, then you should biopsy Thank you! Richard C. Allen MD PhD FACS richardcutlerallen@gmail.com Oculoplastic Surgery Video Library
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