Challenges in Managing Eyelid Basal Cell Carcinoma with Mohs Surgery and Close the Large Eyelid Defect after Tumor Removal
Article Sidebar
Abstract
Background: Basal cell carcinoma (BCC) is the most common skin cancer of the eyelid. The important things management we have to emphasize are to prevent recurrence rate and to get the good cosmetic result after reconstruct the large defect. The aim of this case report is to show the management of both eyelid basal cell carcinoma and large eyelid defect after tumor removal.
Methods: Case Report. A Woman 40 years old was reffered from Dermatovenereology Department of Cipto Mangunkusumo Hospital with aggressive type BCC. The location of the tumor was at inferior left eyelid with size of 18 x 19 mm. They planned to perform Mohs’ surgery and consulted to Plastic and Reconstruction division of Ophthalmology Department for eyelid reconstruction. After Mohs’ surgery the horizontal length of the eyelid defect was more than 50% and vertical defect was more than 15 mm. The Mustarde cheek advancement flap were choosen.
Results: Post operation necrotic tissue was noted do to ischemic problem. Oral corticosteroid was given with tapering dose for six days. One month later, the condition was improved and Dermatovenereology department performed diode laser for the necrotic tissue and further showing good result.
Conclusion: The management for eyelid BCC were still challenging including the technique to reconstruct the large eyelid defect, the risk of recurrence after the tumor removal and post operative result. The dicision to choose the proper technique to reconstruct the eyelid defect and tight follow-up after surgery will give optimal functional and cosmetic result.
Â
Keywords: basal cell carcinoma; Mohs surgery; Mustarde cheek advancement flap; necrotizing flap; corticosteroid; diode laser
Full text article
References
Ormerod A, Rajpara S, Craig F. Basal cell carcinoma. British Medical Journal 2010; 4(1719): 1-34.
Jonathan J. Management Of Periocular Basal Cell Carcinoma.Surv Ophthalmol 1993; 38(2): 210-2.
NCCN Clinical Practice Guidelines in Oncology. Basal Cell and Squamous Cell Skin Cancers. National Comprehensive Cancer Network. Report number: 1, 2007.
Leatherbarrow B. Tumour management and repair after tumour excision. In: Collin R, Rose G (eds.)Fundamentals of Clinical Ophthalmology Plastic and Orbital Surgery. 1st ed. London: BMJ Books; 2001. p44-66.
Anderson RL, Ceilley RI. A Multispecialty Approach To The Excision And Reconstruction Of Eyelid Tumors. Ophthalmology1978; 85(11): 1150-63.
Rosner M. Basal cell carcinoma. In: Singh AD, Damato BE, Pe’er J, Murphree AL, Perry JD (eds.)Essentials of Ophthalmic Oncology. 1st ed. United State of America: Slack Incorporated; 2010. p76-80.
Avril MF, Auperin A, Margulis A, Gerbaulet A, Duvillard P, Benhamou E, et all. Basal cell carcinoma of the face: surgery or radiotherapy? Results of a randomized study. British Journal of Cancer 1997; 76(1): 100-6.
Ahmad J, Mathes DW, Itani KM. Reconstruction of the Eyelids after Mohs Surgery. Semin Plast Surg 2008; 22: 306-18.
Abdallah AM. Reconstruction of Eyelid Defects after Excision of Eyelid Tumors. Saudi Journal of Ophthalmology 2006; 20(3): 196-204.
M. Accuracy of Clinical Diagnosis of Cutaneous Eyelid Lesions. Ophthalmology 1997; 104: 479-84.
Rene C. Oculoplastic aspects of ocular oncology. Eye 2013; 27: 199-207.
Jahan-Tigh RR, Migden MR. Incorporating Treatment Advances for Basal Cell Carcinoma Into Clinical Practice. http://www.medscape.org (accessed 12 December 2014).
Cigna E, Tarallo M, Maruccia M, Sorvillo V, Pollastrini A, Scuderi N. Basal Cell Carcinoma: 10 Years of Experience. Journal of Skin Cancer 2011: 1-5.
Dhingra N, Gajdasty A, Neal JW, Mukherjee AN, Lane CM. Confident complete excision of lid-margin BCCs using a marginal strip: an alternative to Mohs’ surgery. Br J Ophthalmol 2007; 91: 794-6.
Connolly SM, Baker DR, Coldiron BM, Fazio MJ, Storrs PA, Vidimos AT. AAD/ACMS/ASDSA/ASMS 2012 appropriate use criteria for Mohs micrographic surgery: A report of the American Academy of Dermatology, American College of Mohs Surgery, American Society for Dermatologic Surgery Association, and the American Society for Mohs Surgery. J Am Acad Dermatol 2012; 67(4): 531-50.
Jean L. Bolognia, MD, Joseph L. Jorizzo, MD and Julie V. Schaffer, MD. Mohs Surgery. In: Bolognia JL, Jorizzo JL, Schaffer JV (eds.)Dermatology. 3rd ed. England: elsevier; 2012. p2445-55.
Inkster C, Ashworth J, Murdoch JR, Montgomery P, Telfer NR, Leatherbarrow B. Oculoplastic reconstruction following Mohs surgery. Eye 1998; 12: 214-8.
Sub-bagian Plastik Mata dan Rekonstruksi. Prosedur Diagnostik Bedah Plastik Mata dan Rekonstruksi. Fakultas Kedokteran Universitas Indonesia. Report number: 1, 2010.
Long JA. Mohs reconstruction. In: Roy FH, Benjamin L (eds.)Surgical Techniques in Ophthalmology: Oculoplastic Surgery. 1st ed. England: Saunders Elsevier; 2009. p111-25.
Jackson IW, Pacheco EM. Flaps, Grafts, and Alloplastic Materials in Lid Reconstruction and Repair. Pennsylvania: 
Lippincott Williams & Wilkins; 2006. http://www.eyecalcs.com/ (accessed 29 January 2015).
Subramanian N. Reconstructions of eyelid defects. Indian J Plast Surg 2011; 44(1): 5-13.
23.
Arnold MG, Chu EA, Odland RM. Skin Flap Physiology and Wound Healing. In: Flint PW, Haughey BH, Lund V, Niparko JK, Robbins KT, Thomas JR, et al (eds.)Cummings Otolaryngology. 6th ed. Philadelphia: Saunders Elsevier; 2015. p1124-36.
Pang CY, Neligan PC. Flap pathophysiology and pharmacology. In: Neligan PC (eds.)Plastic Surgery Six Volumes. 3rd ed. Canada: Elsevier; 2013. p573-86.
Weissman O, Farber N, Remer E, Tessone A, Trivizki O, Bank J, et al. Post-facelift flap necrosis treatment using charged polystyrene microspheres. Can J Plast Surg 2013; 21(1): 45-7.
Gladstone G, Myint S, Black EH, Brazzo BG, Nesi FA. Fundamentals of Facelift Surgery. Ophthalmol Clin N Am 2005; 18: 311-7.
Hopkins JT, McLoda TA, Seegmiller JG, Baxter D. Low-Level Laser Therapy Facilitates Superficial Wound Healing in Humans: A Triple-Blind, Sham-Controlled Study. Journal of Athletic Training 2004; 39(3): 223-9.
Inck EM, Cagnie BJ, Cornelissen MJ, Declercq HA, Cambier DC. Increased fibroblast proliferation induced by light emitting diode and low power laser irradiation. Lasers Med Sci 2003; 18: 95-9.
Shnitkind E, Yaping E, Geen s, Shalita AR, Lee WL. Anti- inflammatory properties of narrow-band blue light. J Drugs Dermatol 2006; 5: 605-10.
Barlow RJ, Hruza GJ. Laser and light tissue interaction. Goldberg DJ. In: Laser and Light. 1st ed. Philadelphia: Elsevier; 2005. p1-10.
Avci P, Gupta A, Sadasivam M, Vecchio D, Pam Z, Pam N, et al. Low-level laser (light) therapy (LLLT) in skin: stimulating, healing, restoring. Semin Cutan Med Surg 2013; 32(1): 41-52.