A Systematic Review Article on Orbital Exenteration: Indication, Complications and Reconstruction Methods.

Orbital exenteration is a surgical procedure that removes varying degrees of the orbital contents and periorbital soft tissue, including periorbital skin, the globe, extraocular muscles, optic nerve, the periorbita, and the orbital fat. In some instances, the disease process may necessitate removal of the bony orbital walls as well. Orbital exenteration is reserved for highly malignant and potentially fatal neoplasms originating from the ocular adnexal structures; ocular tumors with extension to the orbital soft tissue; orbital extension of tumors of the paranasal sinuses or nasal cavity; and orbital extension from intracranial processes. Tumors necessitating orbital exenteration may include squamous cell carcinoma, basal cell carcinoma, sebaceous carcinoma, melanoma of the conjunctiva, uveal melanoma with extrascleral or orbital extension, epithelial cancers such as adenoid cystic carcinoma of the lacrimal gland, rhabdomyosarcoma, and other rare tumors. The indications for orbital exenteration in a number of previously published series are summarized in Table 23-1. In addition to cancers, nonmalignant neoplasms—such as neurofibromatosis causing severe orbital displacement, immobility, and blindness or extensive lymphangioma compromising function and cosmesis—may also lead to orbital exenteration. Nonneoplastic diseases of rapidly infiltrative nature, either inflammatory or infectious, and nonneoplastic diseases associated with refractory orbital pain may also be indications for orbital exenteration. Examples include invasive fungal infections of the orbit such as mucormycosis; orbital socket contracture after enucleation causing severe pain; and extreme cases of Graves orbitopathy unresponsive to other treatment modalities. Orbital exenteration results in complete loss of vision in the affected eye as well as significant disfigurement of the upper face; thus, counseling of the patient prior to surgery and understanding of the patient’s expectations are important to minimize the patient’s distress. During the preoperative interview, the patient’s past medical and surgical history, current medications, coagulation status, and allergies should be ascertained; there should also be a review of systems, with a focus on symptoms of cancer and metastasis. The physical examination should include careful inspection for signs of local or regional extension of disease. Regional lymph node and distant-organ metastasis must be ruled out prior to the decision to proceed with an orbital exenteration.

Orbital exenteration is a disfiguring surgery; its major indication is the treatment of extensive orbito-palpebral malignancies. The reconstruction of the residual cavity is a real challenge despite the different reconstruction techniques, especially on weakened terrain. The purpose of this study was to assess and compare the clinical indications and reconstructive methods and outcomes with previously reported data. A retrospective study was conducted on five patients who underwent orbital exenteration surgery. Those cases were collected in the department of plastic, reconstructive and burns surgery at the Al kortobi Hospital in tangier (Morocco) between mars 2021 and June 2022. The main outcome measures were demographics surgery type, clear margins histologically, surgical complications and local recurrence. Five patients were included in this study, 3 men and 2 women with an average age of 75 years old (60 to 90 years old), mean follow up was 5 months. All patients presented with a tumor in the eyelid or periocular skin, diagnosis included basal cell carcinoma in three patients and squamous cell carcinoma in the other two. Total orbital exenteration was performed in all patients, the cavity was filled with a temporalis muscle flap in four cases and with a local flap (type LLL= dufourmental flap) in one case. Clear margins tumor was obtained in all cases and no complications or recurrence were seen so far. Adjuvant radiation therapy was conducted on three cases. Reflecting the literature on the subject, exenteration aims at local control of disease invading the orbit that is potentially fatal or relentlessly progressive. We have promoted reconstruction using the temporal muscle flap thanks to its advantages such as a single operative step thus reducing operative morbidity, good skin coverage, fast healing and fewer postoperative complications. In term of our study, orbital exenteration retains its place in orbito-palpebral cancer surgery, while the temporal .......

L’exentération orbitaire a-t-elle encore sa place en 2019 ?

Chromosome 9 Allele Loss Occurs in both Basal and Squamous Cell Carcinomas of the Skin

Orbital Exenteration for Advanced Peri‐orbital Skin Cancer: Prognostic Factors and Survival

Keratinocyte carcinoma (ie, cutaneous basal and squamous cell carcinoma) is the most common cancer in the United States. To determine whether topical fluorouracil could prevent surgically treated keratinocyte carcinoma. The Veterans Affairs Keratinocyte Carcinoma Chemoprevention Trial was a randomized, double-blind, placebo-controlled trial of topical fluorouracil for chemoprevention of keratinocyte carcinoma. Participants were recruited from May 2009 to September 2011 from 12 Veterans Affairs medical centers and followed until June 30, 2013. Participants were veterans (n = 932) with a history of at least 2 keratinocyte carcinomas in the past 5 years; almost all were white males and the median age was 70 years. Application of fluorouracil, 5%, (n = 468) or vehicle control cream (n = 464) to the face and ears twice daily for 2 to 4 weeks upon randomization. Surgically treated keratinocyte, basal cell, and squamous cell carcinoma risk on the face and ears in the first year after enrollment; and time to first surgically treated keratinocyte, basal cell, and squamous cell carcinoma. The a priori hypothesis was that fluorouracil would be effective in preventing these cancers. Of 932 participants (916 men [98%]; 926 white [99%]; median age, 70 years), 299 developed a basal cell carcinoma end point (95 in year 1) and 108 developed a squamous cell carcinoma end point (25 in year 1) over 4 years (median follow-up, 2.8 years). Over the entire study, there was no difference between treatment groups in time to first keratinocyte, basal cell, or squamous cell carcinoma. During the first year, however, 5 participants (1%) in the fluorouracil group developed a squamous cell carcinoma vs 20 (4%) in the control group, a 75% (95% CI, 35%-91%) risk reduction (P = .002). The 11% reduction in basal cell carcinoma risk during year 1 (45 [10%] in the fluorouracil group vs 50 [11%] in the control group) was not statistically significant (95% CI, 39% reduction to 31% increase), nor was there a significant effect on keratinocyte carcinoma risk. However, a reduction in keratinocyte carcinomas treated with Mohs surgery was observed. A conventional course of fluorouracil to the face and ears substantially reduces surgery for squamous cell carcinoma for 1 year without significantly affecting the corresponding risk for basal cell carcinoma. clinicaltrials.gov Identifier: NCT00847912.

Objectives: To clarify the characteristics of Basosquamous cell carcinoma (BSC), this study compares demographic, clinical, therapeutic, histological, and outcome findings of BSCs with those of basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). Methods: The authors classified various definitions of BSC into three groups: the broadest, modest, and narrowest definitions. This study adopted the narrowest definition (both BCC and SCC features with transition zones in between) due to its wide use, its adoption by the World Health Organization, and the least heterogeneous definition. From 2009 to 2018, 20 consecutive cases of BSC presented in a single institution, along with 130 cases of BCC and 81 cases of SCC. Results: The statistically different parameters of BSC compared to BCC or SCC were age (SCC > BSC, BCC), duration (BSC, BCC > SCC), unclear border (BSC > BCC, SCC), higher NCCN classification (BSC, SCC > BCC), safety margin (SCC > BSC > BCC), operation time (BSC, SCC > BCC), reconstruction (less primary closure in BSC than BCC), microscopic size (BSC, SCC > BCC), perineural invasion (BSC > BCC), free lateral margin (BSC, SCC > BCC), and follow-up period (BSC > BCC, SCC). Regarding outcome, one distant metastasis (6.3%) in BSCs, no aggressive consequences in BCCs, and four local recurrences (11.1%), two lymph node metastases (5.6%), and one distant metastasis (2.7%) in SCCs were observed. Conclusions: In this Asian cohort, BSC has a trend toward higher rates of overall adverse outcomes compared to BCC, although this difference did not reach definitive statistical significance, unlike the findings reported in Caucasian populations. Early detection and appropriate treatment at the individual patient level are warranted to minimize rare but clinically relevant adverse events and reproduce favorable outcomes at the population level. Wide local excision followed by local flaps could be a successful surgical option with an adequate safety margin and double histopathologic intraoperative and postoperative check-up.

All-cause mortality in patients with basal and squamous cell carcinoma: A systematic review and meta-analysis

The aim of this study was to evaluate the indications for surgery, patient and healthcare delays, ophthalmic status, challenges of management, complications, disease-free survival (DFS), and overall survival (OS) of patients treated by orbital exenteration at a tertiary care centre. Patients who underwent orbital exenteration during an 18-year period (2005-2022) were identified from the Helsinki University Hospital (Helsinki, Finland). Demographic and medical data were retrieved. Sixty-nine patients were included. Median age was 74 years (range, 7-93 years). The most common operative indication for exenteration was a malignant tumour (99%). Histopathological types that were most frequently encountered were uveal melanoma in 10 (14%), basal cell carcinoma in 9, (13%) and cutaneous squamous cell carcinoma in 8 (12%) patients. Orbital exenteration could have been avoided in 32 (46%) patients if the primary surgery had been performed with sufficient margins and without delay. The median follow-up time was 16 months (range, 0-169 months). At the end of follow-up, 34 (49%) patients had no evidence of disease, 12 (17%) were alive with disease and 23 (33%) had died of the disease. Kaplan-Meier analysis revealed 1- and 2-year DFS of 74% and 67%, respectively. One- and 2-year OS were 77% and 69%, respectively. Selected periorbital malignancies, especially those with insufficient primary treatment or with treatment delay, may warrant exenteration. Given the diverse origins of malignancies, a multidisciplinary approach, including ophthalmological consultation, appears to be the optimal strategy for these patients.

Maria Sternemann Thomas Wiegel Christoph C. Geilen Constantin E. Orfanos Wolfgang Hinkelbein Basel S. Karger Controversies in the Treatment of Skin Neoplasias 2006 180 pp. $162 hardcover ISBN: 3-8055-8014-2.

The human lectin galectin-7 (Gal-7; p53-induced gene-1) has anti- and pro-malignant features in different in vitro models. We tried to clarify relation of its expression to cellular and clinical parameters in head and neck squamous and basal cell carcinomas. Using a non-cross-reactive antibody, immunohistochemical staining in squamous cell epithelia (epidermis, epithelium of oropharynx and larynx) (n = 57), squamous cell carcinomas (n = 47) and lymph node metastases (n = 25), as well as basal cell carcinomas (n = 10) were studied. This monitoring was flanked by processing to assess the level of differentiation (cytokeratins 10 and 14), proliferation (Ki67) and basal lamina formation (collagen IV). The results were correlated with clinical and pathological findings (grading, TNM-staging, extracapsular spread, angio- and lymphangioinvasion, perineural invasion, recurrence and survival). Gal-7 resides in all layers of epithelia with cytoplasmic and nuclear localization in normal specimens. Basal cell carcinomas were devoid of the Gal-7 respective signal. Squamous cell carcinomas were positive, presenting different staining profiles. Intense staining was predominantly found in squamous cell cancers with high degrees of differentiation and keratinization. Fittingly, poor level of differentiation (P = 0.0009), absence of keratinization (P = 0.0105) and significant discontinuity or absence of collagen IV expression in the peritumoral basal lamina (P = 0.0024) was found in Gal-7-negative tumors. Gal-7 presence was not related to gender, primary tumor site, T-stage, N-stage, clinical stage, extracapsular spread, angio- and lymphangioinvasion, perineural spread or treatment outcome at a statistically significant level. Immunohistochemical analysis revealed a positive correlation for differentiation and keratinization to Gal-7 presence in squamous cell carcinomas. Absence of Gal-7 expression was detected in basal cell carcinomas. These clinical data delineate Gal-7 influence on differentiation in vivo, without evidence for a role in dissemination reported for lymphoma.

XPA, haplotypes, and risk of basal and squamous cell carcinoma

<div>Abstract<p><b>Background:</b> Elevated keratinocyte carcinoma risk is present with several immune-related conditions, e.g., solid organ transplantation and non-Hodgkin lymphoma. Because many immune-related conditions are rare, their relationships with keratinocyte carcinoma have not been studied.</p><p><b>Methods:</b> We used Medicare claims to identify cutaneous squamous cell carcinoma (SCC) and basal cell carcinoma (BCC) cases in 2012, and controls matched on sex and age. All subjects were aged 65 to 95 years, of white race, and had attended ≥1 dermatologist visit in 2010–2011. Immune-related conditions were identified during 1999–2011 using Medicare claims. Associations were estimated with logistic regression, with statistical significance determined after Bonferroni correction for multiple comparisons.</p><p><b>Results:</b> We included 258,683 SCC and 304,903 BCC cases. Of 47 immune-related conditions, 21 and 9 were associated with increased SCC and BCC risk, respectively. We identified strongly elevated keratinocyte carcinoma risk with solid organ transplantation (SCC OR = 5.35; BCC OR = 1.94) and non-Hodgkin lymphoma (SCC OR = 1.62; BCC OR = 1.25). We identified associations with common conditions, e.g., rheumatoid arthritis [SCC OR = 1.06, 95% confidence interval (95% CI), 1.04–1.09] and Crohn's disease (SCC OR = 1.33, 95% CI, 1.27–1.39; BCC OR = 1.10, 95% CI, 1.05–1.15), and rare or poorly characterized conditions, e.g., granulomatosis with polyangiitis (SCC OR = 1.88; 95% CI, 1.61–2.19), autoimmune hepatitis (SCC OR = 1.81; 95% CI, 1.52–2.16), and deficiency of humoral immunity (SCC OR = 1.51, 95% CI, 1.41–1.61; BCC OR = 1.22, 95% CI, 1.14–1.31). Most conditions were more positively associated with SCC than BCC. Associations were generally consistent regardless of prior keratinocyte carcinoma history.</p><p><b>Conclusions:</b> Many immune-related conditions are associated with elevated keratinocyte carcinoma risk and appear more tightly linked to SCC.</p><p><b>Impact:</b> Immunosuppression or immunosuppressive treatment may increase keratinocyte carcinoma risk, particularly SCC. <i>Cancer Epidemiol Biomarkers Prev; 26(7); 998–1007. ©2017 AACR</i>.</p></div>

Protein kinase C (PKC) isoenzymes transduce signals from cell surface receptors and thereby regulate important cellular functions in skin including keratinocyte growth and differentiation. Overexpression of individual PKC isoenzymes results in aberrant cell growth and in certain instances tumorigenicity. PKC is implicated in tumour promotion in mouse skin. Abnormal expression of PKC has been reported in several human cancers. We have, therefore, investigated expression of PKC-alpha and -beta in basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) by immunohistochemistry. Sections were stained with specific antibodies to PKC-alpha, PKC-beta, CD1a, T cells, B cells and dermal dendritic cells (factor XIIIa), using an immunoperoxidase technique. PKC-alpha and PKC-beta were not detected in tumour cells in BCCs or SCCs. In SCCs, PKC-beta immunostaining revealed positively stained inflammatory and dendritic cells scattered through the stroma; PKC-alpha immunostaining was essentially negative. In contrast, in BCCs, PKC-alpha+ and PKC-beta+ dendritic and spindle-shaped cells were observed in the stroma, immediately adjacent to the tumour islands. Double-labelling experiments showed that a proportion (approximately 20%) of PKC-beta+ dendritic cells also expressed factor XIIIa. BCCs depend on stroma for growth; PKC regulates expression of type IV collagenase and stromelysin III and interactions between tumour and stroma may be important in determining tumour invasion and metastasis. Therefore, overexpression of PKC-alpha and -beta by stromal dendritic cells in BCCs suggests that PKC activation may be involved in stromal/tumour interactions in these tumours.

Objective To estimate the prevalence of cutaneous SCC and BCC in all histologically confirmed skin cancer lesions in African albinos.The following five databases are as follows: African Journals Online (AJOL), PubMed, Europe PMC, and Google Scholar were searched for relevant articles. Study Selection: included studies were case series and cross-sectional studies of histologically confirmed skin cancers in African albinos. Data extraction and synthesis: data extraction and synthesis was informed by the meta-analysis of observational studies in epidemiology guideline. By random effect meta-analysis, we calculated the pooled prevalence of SCC and BCC in skin cancer lesions of the African albinos. Result We abstracted 695 skin cancer lesions from 540 African albinos (275 male and 241 female albinos with sex not stated in 24 subjects). There were 419 SCCs and 249 BCCs. By meta-analysis, the pooled prevalence of SCC is 64% (95% CI; 50–77%). The prevalence for BCC is 31% (95% CI; 19–45%). Conclusion Overall, squamous cell carcinoma is the predominant type of keratinocyte carcinoma reported in African albinos. SCC is preponderant in case series of surgical excision biopsies while BCC predominates in studies reporting on albino skin surveillance programmes.