Author(s): Lisman RD, Jakobiec FA, Small P
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Abstract The extension of sebaceous carcinoma of the eyelid within the epithelium of the palpebral, forniceal, and bulbar conjunctiva (pagetoid spread) is a frequent indication for exenteration, but this recommendation is controversial. Six patients with upper eyelid tumors and variable degrees of epibulbar pagetoid extension were treated without exenteration. All underwent wide local resections of their upper eyelids (repaired by Cutler-Beard procedures), with adjunctive cryotherapy to the involved epibulbar surfaces after preoperative map biopsies of the conjunctiva had been done. Cryotherapy was applied during the second-stage Cutler-Beard procedure after initial resection of the tumor bulk. Follow-ups ranging from 12 to 50 months, with conjunctival biopsies at 6-month intervals, showed no recurrence of pagetoid tumor. Although exenteration was avoided, dry-eye symptoms, symblepharon, corneal erosion, and vascularization were side effects, which the patients were willing to tolerate to avoid radical surgery. The complications were most severe in the two patients who were either elderly or had more than two quadrants of epibulbar pagetoid disease.
This article was published in Ophthalmology
and referenced in Journal of Clinical & Experimental Dermatology Research