Supit Tommy, Nugroho Trilaksana, Fitrikasari Alifiati
Department of General Surgery, Faculty of Medicine Diponegoro University, Dr. Kariadi General Hospital, Jl. Dr. Sutomo No. 16, Randusari, Semarang Selatan, Semarang, Jawa Tengah, 50244, Indonesia.
Department of Plastic Surgery, Faculty of Medicine Diponegoro University, Dr. Kariadi General Hospital, Jl. Dr. Sutomo No. 16, Randusari, Semarang Selatan, Semarang, Jawa Tengah, 50244, Indonesia.
Ann Med Surg (Lond). 2021 Jan 26;62:391-394. doi: 10.1016/j.amsu.2021.01.069. eCollection 2021 Feb.
and importance: Conjunctival melanoma (CM) is a rare and potentially lethal ocular tumor. As with any oncologic disease, early diagnosis and appropriate treatment of CM is paramount to limit morbidity and increase life expectancy. However, patients with severe mental disability with social isolation are usually presented in late-stage disease.
This report presents a case of a 55-year-old man with paranoid schizophrenic man with an extraordinarily large CM due to neglect. The patient suffered from complete left eye blindness with no clinical and radiological evidence of metastasis.
Clinicians must bear in mind the limited patient compliance and family support of mentally-ill patients that restricts treatment modalities that would have otherwise been applicable for cooperative patients. The importance multidisciplinary approach, choosing the simpler but effective surgical technique should be prioritized.
Left exenteration and tumor wide excision was performed. The left orbital defect was reconstructed using forehead flap and split-thickness skin graft (STSG). The uncooperative nature of the patient posed early post-operative challenges that necessitates subsequent operation to drain seroma. The patient was discharged 16-days after operation with acceptable cosmetic and clinical results. However, the patient failed to return to the clinic for longer post-operative evaluation.
A multidisciplinary approach is mandatory to treat complex cases such as this report. Surgeons are advised to adopt simpler surgical approach that will require minimal self-care and should encourage family members to continuously support the patient.
及重要性：结膜黑色素瘤（CM）是一种罕见且具有潜在致命性的眼部肿瘤。与任何肿瘤性疾病一样，CM的早期诊断和恰当治疗对于降低发病率和提高预期寿命至关重要。然而，患有严重精神残疾且社会孤立的患者通常在疾病晚期才被发现。
本报告介绍了一例55岁患有偏执型精神分裂症的男性患者，因被忽视而患有异常巨大的CM。该患者左眼完全失明，无转移的临床及影像学证据。
临床医生必须牢记，精神病患者的患者依从性和家庭支持有限，这限制了原本适用于合作患者的治疗方式。多学科方法的重要性，应优先选择更简单但有效的手术技术。
进行了左眼眼球摘除及肿瘤广泛切除。使用额部皮瓣和中厚皮片移植（STSG）修复左眼眶缺损。患者不合作的性质给术后早期带来了挑战，需要后续手术引流血清肿。患者术后16天出院，美容和临床效果可接受。然而，患者未能返回诊所进行更长时间的术后评估。
对于此类复杂病例，多学科方法是必不可少的。建议外科医生采用更简单的手术方法，这种方法需要最少的自我护理，并应鼓励家庭成员持续支持患者。
