Gniesmer S, Sonntag S R, Schiemenz C, Ranjbar M, Heindl L M, Varde M A, Emmert S, Grisanti S, Kakkassery V
Klinik für Augenheilkunde, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland.
Zentrum für Augenheilkunde, Medizinische Fakultät und Universitätsklinikum Köln, Universität zu Köln, Köln, Deutschland.
Ophthalmologie. 2023 Mar;120(3):262-270. doi: 10.1007/s00347-023-01820-w. Epub 2023 Feb 9.
Malignant tumors of the eyelid are much less frequent than benign eyelid alterations. These are frequently incidental findings without symptoms which are often overlooked or misinterpreted by patients.
This article gives an overview of clinical aspects, diagnostics and treatment of the five most common malignant eyelid tumors and exemplarily explains the essential principles of evidence-based treatment of malignant eyelid tumors.
This narrative review was prepared based on a selective literature search. The depiction of the treatment of eyelid tumors is supported by illustrations of clinical cases.
The medical history and inspection provide initial indications of malignancy. Every eyelid change suspected of being malignant should be examined histologically to confirm a diagnosis. By far the most common malignant eyelid tumor in Europe is basal cell carcinoma, which metastasizes only in exceptional cases. Squamous cell carcinomas, sebaceous adenocarcinomas, melanomas and Merkel cell carcinomas occur much less frequently. In these cases, potential metastasis in particular must be considered when making the diagnosis and staging has to be initiated. Surgical excision into healthy tissue with tumor-free margins is the gold standard for malignant eyelid tumors. Non-surgical adjuvant or neoadjuvant forms of evidence-based treatment can be initiated based on the individual case to minimize the risk of recurrence and metastasis.
It is essential to recognize eyelid changes at an early stage, to classify them correctly and to initiate the appropriate treatment. The interaction between the general condition and the personal needs of a patient as well as state of the art medicine are the keys to a good personalized treatment.
眼睑恶性肿瘤比眼睑良性病变少见得多。这些病变常常是偶然发现，没有症状，患者常常忽视或误解这些病变。
本文概述了五种最常见的眼睑恶性肿瘤的临床情况、诊断和治疗，并举例解释了眼睑恶性肿瘤循证治疗的基本原则。
本叙述性综述基于选择性文献检索编写。眼睑肿瘤治疗的描述辅以临床病例插图。
病史和检查提供了恶性肿瘤的初步迹象。每一个怀疑为恶性的眼睑病变都应进行组织学检查以确诊。在欧洲，迄今为止最常见的眼睑恶性肿瘤是基底细胞癌，仅在极少数情况下发生转移。鳞状细胞癌、皮脂腺腺癌、黑色素瘤和默克尔细胞癌的发生频率要低得多。在这些病例中，诊断时尤其必须考虑潜在的转移情况，并必须开始进行分期。手术切除至切缘无肿瘤的健康组织是眼睑恶性肿瘤的金标准。可根据具体病例启动非手术辅助或新辅助循证治疗形式，以尽量降低复发和转移风险。
早期识别眼睑病变、正确分类并启动适当治疗至关重要。患者的一般状况与个人需求以及医学前沿之间的相互作用是实现良好个性化治疗的关键。
