Tong Jessica Y, Martin Peter A, Tumuluri Krishna, Selva Dinesh
Save Sight Institute, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
South Australian Institute of Ophthalmology, Royal Adelaide Hospital, Adelaide, Australia.
Ophthalmic Plast Reconstr Surg. 2023;39(4):374-380. doi: 10.1097/IOP.0000000000002328. Epub 2023 Feb 28.
Globe-sparing excision for periocular basal cell carcinoma (BCC) with orbital invasion has evident benefits, but the ensuing morbidity and characteristics of recurrence are not well elucidated. This study aims to describe the extent of visual morbidity following globe-sparing excision, and the clinicoradiological characteristics of tumor recurrence.
Multicentre retrospective case series.
Eight patients were identified for inclusion in this series. Time to recurrence following globe-sparing excision ranged from 3 to 12 years. Seven patients (87.5%) presented with recurrent disease originating from the medial canthus. Clinical features at presentation included contracture ( n =4, 50.0%), upper lid ptosis ( n =3, 37.5%), a palpable mass ( n =2, 25.0%), and hypoesthesia ( n =2, 25.0%). Radiologically, tumor recurrence was predominantly characterized by isointense signals on T1 and T2-weighted sequences ( n =5, 62.5%) with moderate contrast enhancement. The most common histologic subtype in recurrent tumors was a mixed nodular and infiltrative growth pattern ( n =5, 62.5%). Perineural invasion was a feature in four (50%) cases. Salvage therapy in the form of exenteration was performed in seven cases. Vismodegib and adjuvant radiotherapy were provided for one case with surgically unresectable tumor recurrence.
Globe-sparing excision for invasive periocular BCC can be complicated by late recurrence that develops rapidly despite silent neuroimaging for years. Early clinical signs are subtle. High-risk features predictive of recurrence include medial canthus location, mixed histological subtypes, and perineural invasion. Patients with such characteristics require lifelong clinical and imaging surveillance following globe-sparing excision.
对伴有眶内侵犯的眼周基底细胞癌（BCC）进行眼球保留切除术有明显益处，但随之而来的发病率及复发特征尚未得到充分阐明。本研究旨在描述眼球保留切除术后视力损害的程度以及肿瘤复发的临床放射学特征。
多中心回顾性病例系列研究。
本系列共纳入8例患者。眼球保留切除术后复发时间为3至12年。7例患者（87.5%）复发疾病起源于内眦。复发时的临床特征包括挛缩（n = 4，50.0%）、上睑下垂（n = 3，37.5%）、可触及肿块（n = 2，25.0%）和感觉减退（n = 2，25.0%）。放射学上，肿瘤复发主要表现为T1和T2加权序列上等信号（n = 5，62.5%），伴有中度对比增强。复发肿瘤中最常见的组织学亚型是结节性和浸润性混合生长模式（n = 5，62.5%）。4例（50%）病例有神经周围侵犯。7例患者接受了眶内容剜除术作为挽救性治疗。1例手术无法切除的肿瘤复发患者接受了维莫德吉和辅助放疗。
对侵犯性眼周BCC进行眼球保留切除术可能会出现晚期复发，尽管多年来神经影像学检查无异常，但复发进展迅速。早期临床体征不明显。预测复发的高危特征包括内眦位置、混合组织学亚型和神经周围侵犯。具有这些特征的患者在眼球保留切除术后需要终身进行临床和影像学监测。
