Periocular tumors and reconstruction
Periocular tumors are growths that occur in the regions surrounding the eye, including the eyelids, cheeks, orbit, and adjacent facial structures. These tumors can be either benign or malignant, as shown in the above image depicting a basal cell carcinoma. Early diagnosis and treatment are crucial, particularly for malignant tumors, as they can pose serious risks to vision and overall health.
In the sensitive periocular area tumors should not be ignored. Neglecting a periocular tumor can lead to significant progressive involvement of the area around the eye, which may ultimately necessitate the removal of the eye to preserve more critical structures, essential for the patient's survival.
In the image below, we see a case of basal cell carcinoma of the lower eyelid, above right after the tumor has been removed and below after plastic reconstruction of the area.
Types of Periocular Tumors
Benign Tumors
These include non-cancerous growths such as chalazion, xanthelasma, various cysts, and nevi. Although these tumors are usually not life-threatening, they may require removal if they cause discomfort, aesthetic issues, or interfere with vision.
Malignant Tumors
The most common malignant periocular tumor is basal cell carcinoma, which, while rarely metastatic, can cause significant local tissue destruction. Other malignancies include squamous cell carcinoma, which has a significantly higher metastatic potential, sebaceous gland carcinoma, known for its aggressive nature, and melanoma, which is particularly dangerous due to its ability to spread to other parts of the body.
In the image below, we see a case of basal cell carcinoma of the upper eyelid, first before the tumor removal and below that after the plastic reconstruction of the area. The upper eyelid is a particularly challenging area to reconstruct and should only be handled by oculoplastic surgeons.
Symptoms and Diagnosis
Patients with periocular tumors may notice visible growths, skin ulcers, changes in skin color or texture, persistent irritation, or changes in vision. A thorough clinical examination is the first step in diagnosis, often followed by imaging techniques such as CT scans, MRI, or ultrasound to assess the extent of the tumor. In many cases, a biopsy is performed to determine whether the tumor is benign or malignant, guiding the treatment approach.
Below, we see a case of surgical reconstruction of the outer canthal area.
Surgical Management and Reconstruction
Surgical removal is the treatment of choice for both benign and malignant periocular tumors. The goals of surgery are to completely remove the tumor while preserving as much normal tissue as possible.
A biopsy of the removed tissue should always be performed for potentially malignant tumors to ensure that the margins are clear and to minimize tissue loss that a secondary procedure might cause.
After the tumor is removed, surgical reconstruction of the area plays a crucial role in restoring both function and appearance. Reconstruction options vary depending on the size and location of the defect:
Primary Closure : Although the easiest to perform, it is rarely the best option in the periocular area.
Local Flaps : Tissue from adjacent areas can be moved to cover the wound.
Tissue Grafting : When local tissue is insufficient, a graft from another part of the body may be used to cover the defect.
Below, we see a case of surgical reconstruction of the upper inner canthus.
Postoperative Care and Outcomes
Postoperative care is critical for successful healing and includes careful monitoring of the surgical site, managing any complications, and ensuring patient comfort. Most patients experience excellent outcomes with restored function and appearance, although some may require additional treatments for optimal results.
Here, we see a case in the lower inner canthus and the cheek, an area that is particularly challenging to reconstruct.
Conclusion
The management of periocular tumors requires early diagnosis, adequate removal, and effective reconstruction. Early diagnosis and treatment are essential for achieving the best possible outcomes. If you notice any abnormal growths or changes around your eyes, it is important to consult an oculoplastic surgeon immediately.
Eye and Eyelid clinic
