Hogarty Daniel T, Dewhurst Nicholas G, Burt Benjamin
Bendigo Eye Clinic, Bendigo, VIC, Australia,
Royal Victorian Eye and Ear Hospital, Melbourne, VIC, Australia.
Int Med Case Rep J. 2018 Jul 31;11:177-179. doi: 10.2147/IMCRJ.S168666. eCollection 2018.
Orbital invasion of periocular basal cell carcinoma (BCC) is a potentially life-threatening condition with high levels of ocular morbidity. Exenteration results in significant disfigurement and permanent loss of vision. We report our experience with a patient who presented with medial orbit invasion of a BCC following 2 previous microscopically adequate local excisions of medial canthal BCC, an adequate Moh's micrographic surgical excision of the tumor, and radiotherapy. The patient underwent an orbital excision where the tumor was found to have perineural involvement and extend beyond the posterior margin. Following the pathology results of this procedure, the patient opted to try vismodegib (Erivedge®) to delay exenteration for as long as possible.
A course of vismodegib was taken by the patient with minor side effects (partial alopecia, mild dysgeusia and hyposmia, and minor muscle cramps). Subsequent imaging demonstrated no recurrence of the orbital tumor 29 months after orbital excision.
We demonstrate the use of vismodegib with local orbital excision as an eye-saving alternative to exenteration for advanced orbital metastasis of BCC.
眼周基底细胞癌（BCC）侵犯眼眶是一种潜在的危及生命的疾病，眼部发病率很高。眶内容剜除术会导致严重毁容和永久性视力丧失。我们报告了一名患者的情况，该患者在先前两次对内眦BCC进行显微镜下充分的局部切除、一次对肿瘤进行充分的莫氏显微外科切除以及放疗后，出现了BCC侵犯眼眶内侧的情况。患者接受了眼眶切除术，术中发现肿瘤有神经周围侵犯且超出后缘。根据该手术的病理结果，患者选择尝试维莫德吉（Erivedge®）以尽可能长时间推迟眶内容剜除术。
患者服用了一个疗程的维莫德吉，出现了轻微副作用（部分脱发、轻度味觉障碍和嗅觉减退以及轻微肌肉痉挛）。随后的影像学检查显示，眼眶切除术后29个月眼眶肿瘤未复发。
我们证明了维莫德吉联合局部眼眶切除术可作为BCC晚期眼眶转移患者避免眶内容剜除术的一种挽救视力的替代方法。
