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Surgery of the Eyelid, Lacrimal System, and Orbit$
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Michael T Yen

Print publication date: 2011

Print ISBN-13: 9780195340211

Published to Oxford Scholarship Online: November 2020

DOI: 10.1093/oso/9780195340211.001.0001

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PRINTED FROM OXFORD SCHOLARSHIP ONLINE (oxford.universitypressscholarship.com). (c) Copyright Oxford University Press, 2021. All Rights Reserved. An individual user may print out a PDF of a single chapter of a monograph in OSO for personal use. date: 22 September 2021

Management of Periocular Neoplasms

Management of Periocular Neoplasms

(p.25) 3 Management of Periocular Neoplasms
Surgery of the Eyelid, Lacrimal System, and Orbit

Robert C. Kersten

Oxford University Press

Epithelial malignancy of the eyelid is a common problem, representing about 14% of skin cancers in the head and neck region. The goals when treating any skin cancer are complete elimination of the tumor and minimal sacrifice of normal adjacent tissues. These concepts are of paramount importance when treating periocular epithelial malignancies because of the complex nature of the periocular tissues and their critical function in protecting the underlying globe, as well as the increased risk that recurrent tumor in this area poses. Many modalities have been advocated, by a variety of medical practitioners, for the treatment of epithelial malignancies in the periocular region. There are two key considerations in selecting a treatment for skin cancers. The first is that the selected modality must be capable of eradicating all tumor cells to which it is applied. The second is that some mechanism must exist to ensure that it is applied to all the existing tumor cells. Because tumors of the lid margins and canthi often exhibit slender strands and shoots of cancer cells that may infiltrate beyond the clinically apparent borders of the neoplasm, appropriate monitoring to ensure that the treatment modality reaches all of the cancer cells is essential. Numerous studies have demonstrated that clinical judgment of tumor margins is inadequate, significantly underestimating the area of microscopic tumor involvement. The introduction of frozen-section control to document adequacy of tumor excision marked a major advancement in the treatment of eyelid malignancies and now represents the standard of care. Any treatment modality that does not use microscopic monitoring of tumor margins must instead encompass a wider area of adjacent normal tissue in hopes that any microscopic extensions of tumor will fall within this area. The purpose of this chapter is to explore alternative methods of periocular cancer treatment. Mohs micrographic technique is a refinement of frozen-section control of tumor borders that, by mapping tumor planes, allows a three-dimensional evaluation of tumor margins rather than the two-dimensional examination provided by routine frozen section. The modality was initiated by Frederick E. Mohs, MD, in 1936.

Keywords:   Actinic keratosis, Bulbar conjunctiva, Cancer necrosis, Imiquimod, Keratoacanthoma, Melanoma, Periocular skin cancers

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