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Dinesh Selva

Publications and source records attributed to Dinesh Selva.

At least 109 records · Page 6Linked to original sources
PubMed2003

Mapped serial excision for periocular lentigo maligna and lentigo maligna melanoma.

PURPOSE: To report the early cure rate for periocular lentigo maligna (LM) and LM melanoma (LMM), using modified Mohs surgery with vertically cut paraffin-embedded sections (mapped serial excision [MSE]). A secondary aim was to identify differences in the clinical features and outcomes between periocular LM and LMM and those found elsewhere on the head and neck. DESIGN: Prospective, noncomparative, interventional case series. PARTICIPANTS: One hundred thirty-five patients undergoing 141 MSE procedures. METHODS: A prospective series of 141 MSE procedures for LM and LMM over a 10-year period (1993-2002) in a single-center Mohs surgical unit. MAIN OUTCOME MEASURES: Recurrence, site, size of LM or LMM, invasiveness, prior recurrence, clear margin of excision, size of final defect, and number of levels required for complete excision. RESULTS: One hundred forty-one MSE procedures, of which 23% (32/141) were for LMM and 19% (27/141) were for periocular lesions. Location or prior recurrence were not predictive of invasive disease; however, the size distribution of the initial lesion (P = 0.0354) and the final defect after MSE (P = 0.0183) were larger in LMM. Thirty-one percent of LM and 14% of LMM less than 1 mm thick required larger than 5-mm and 1-cm margins, respectively, for complete excision. Mean follow-up of 32 months (range, 1-100 months) revealed 4 recurrences (3%), of which two were periocular (P = 0.188). CONCLUSIONS: Our review is the largest prospective series of MSE for LM and LMM and suggests that it is the treatment of choice in these forms of melanoma. Mapped serial excision offers a high early cure rate in conjunction with tissue conservation, which is of particular relevance in the periocular region. There were no significant differences between periocular LM and LMM and those found elsewhere in the head and neck region. It also appears that the current recommendations of 5-mm margins for in situ melanoma (LM) and 1-cm margins for melanoma less than 1 mm thick are insufficient for complete excision of LM or LMM, emphasizing the importance of margin-controlled excision of these lesions.

Adult↗
PubMed2003

Trichilemmal carcinoma of the upper eyelid.

INTRODUCTION: Trichilemmal carcinoma (TLC) is a rare adnexal tumour related to the external hair sheath. We describe the first case of TLC on the upper eyelid to be treated with Mohs micrographic surgery. CASE REPORT: A 65-year-old man presented with a 2-month history of a firm 4 mm left upper eyelid nodule. An incisional biopsy revealed an infiltrative, lobulated tumour composed of large, polygonal, clear cells. A diagnosis of trichilemmal carcinoma was made and the patient underwent Mohs micrographic surgery. At follow-up 2 years later, there was no evidence of recurrence. CONCLUSION: The pathogenesis of TLC remains unclear, with actinic damage, longterm low dose irradiation and transformation from benign trichilemmoma having been postulated. Trichilemmal carcinomas must be differentiated from other malignant clear cell tumours of the eyelid and the correct diagnosis made promptly as TLC takes an indolent clinical course, in which metastasis is a rare event, despite the tumour's cytologically malignant appearance. We recommend Mohs micrographic surgery as a treatment modality for this tumour, due to its potential for locally aggressive growth and local recurrence.

Aged↗
PubMed2003

Recurrent morphoeic basal cell carcinoma at the lateral canthus with orbitocranial invasion.

We present a case of recurrent, nodulocystic and morphoeic basal cell carcinoma (BCC) at the lateral canthus, with clinically silent orbital and intracranial invasion which was treated with radiotherapy. Orbital invasion is a rare complication of periocular BCC and occurs primarily in high-risk canthal lesions. Preoperative ophthalmological review and imaging should be considered in these cases.

Aged↗
PubMed2003

Pathogenesis of orbital cholesterol granuloma.

Two cases are presented of orbital cholesterol granuloma associated with gradual proptosis arising in men aged 35 and 41 years. Computed tomography demonstrated osteo-lytic masses in the frontal bone at the lacrimal fossa. Curettage revealed a characteristic histology of foreign body reactions surrounding cholesterol clefts. In both cases abnormal bone, more consistent with fibrous dysplasia than reactive change, was found at the periphery. The finding of abnormal bone associated with orbital cholesterol granulomas suggests that a pre-existing bone anomaly may be present in a subset of these cases.

Adult↗
PubMed2003

Craniopharyngioma: a review of long-term visual outcome.

PURPOSE: To assess the clinical presentation and long-term visual outcome in a series of patients with craniopharyn-gioma. METHODS: Retrospective case review. RESULTS: Thirty-six patients were reviewed, comprising 19 female patients and 17 male patients. The age range was 2-77 years with a bimodal distribution of 17 children (mean age 10 years) and 19 adults (mean age 47 years). Blurred vision was the most common visual complaint (23 cases, 64%) and headache the most frequent systemic complaint (19 cases, 53%). The average duration of systemic symptoms was 45 weeks compared to 10 weeks for visual symptoms. Deficits in visual acuity occurred in 13 patients (36%) and showed no significant change from initial presentation to final review. Sixteen patients (44%) had bitemporal hemianopia on presentation and pleomorphism (change from one type of visual field defect to another) occurred in 11 patients. Recurrence of tumour occurred in 15 patients (42%) and was more likely in children (59%) than adults (26%). The mean time period to recurrence was 7 years. The average follow-up period for all cases was 10 years. CONCLUSION: Patients with craniopharyngioma generally present late, and the visual symptoms are often preceded by a long history of systemic symptoms. Children are more likely to present with systemic symptoms than adults. Visual field pleomorphism is a feature of craniopharyngioma and occurred in one-third of the patients. Local recurrence is common. Although magnetic resonance imaging is the recommended means of follow up, regular neuro-ophthalmic review is useful in the early detection of anterior visual pathway compression by recurrent tumour.

Adolescent↗
PubMed2003

Self-inflicted blindness and Brown-Séquard syndrome.

A 30-year-old paranoid schizophrenic man suffered a psychotic episode while flying on an airplane, locked himself in the bathroom, detached the temples of his sunglasses, and stabbed them deeply into both medial orbits. He then secured one temple into the door hinge and rammed the back of his neck repeatedly against it. The injuries caused no light perception from optic nerve trauma and a Brown-Séquard hemitransection of the spinal cord.

Adult↗
PubMed2003

Bilateral dynamic proptosis due to frontoethmoidal sinus mucocele.

A 34-year-old man presented with bilateral inferior and lateral globe displacement and spontaneous, dynamic proptosis in both eyes, pulsatile in nature. Computed tomography and magnetic resonance imaging scans confirmed bilateral frontoethmoidal mucoceles with erosion of the orbital roof, and intracranial extension. Following a transcutaneous mini-trephine of the left orbital mucocele, the dynamic proptosis disappeared, and both proptosis and restriction of eye movements in the left eye improved. This is the first reported case of frontoethmoidal sinus mucocele causing bilateral spontaneous dynamic proptosis.

Adult↗
PubMed2003

Frontoethmoidal osteoma: a stereotactic-assisted sino-orbital approach.

A 28-year-old woman had an extensive osteoma arising in the frontoethmoidal sinuses and involving the orbital roof. The tumor was successfully removed by means of a combined sinus endoscopic and orbital approach, with the assistance of stereotactic localization. The patient had postoperative ptosis, diplopia, and supraorbital nerve anesthesia, which all resolved over a 3-month period. A stereotactic-assisted, sino-orbital approach to selected frontoethmoidal osteomas may provide a viable alternative to an orbitocranial approach.

Adult↗
PubMed2003

Orbitofrontal cholesterol granuloma: percutaneous endoscopic-assisted curettage.

This paper describes the use of endoscopic visualization in curettage of orbital cholesterol granuloma (OCG). Two males aged 54 and 50 years presented with orbitofrontal cholesterol granulomas arising in the superolateral frontal bone and abutting the dura. The granulomas were approached via a superior eyelid crease incision and a 70 degree rigid endoscope was used to visualize curettage of the granuloma from the inner surface of the frontal bone and the dura. Both patients made an uncomplicated recovery and there was no recurrence at eight months and two years follow up. Percutaneous endoscopic curettage is an alternative to blind curettage, lateral orbitotomy or frontal craniotomy for OCG.

Bone Diseases↗
PubMed2003

Thyroid orbitopathy.

BACKGROUND: Thyroid orbitopathy (thyroid eye disease, thyroid ophthalmopathy) is an organ specific, autoimmune disorder with the potential to cause severe functional and psychosocial effects. OBJECTIVE: This article reviews the clinical features with particular emphasis on current management. DISCUSSION: Thyroid orbitopathy is most prevalent in women aged 40-50 years and is usually associated with thyroid dysfunction. Clinical manifestations include soft tissue signs, lid retraction, lid lag, proptosis, restrictive myopathy, corneal exposure and optic neuropathy. Thyroid function tests are essential, while thyroid antibodies and imaging to demonstrate extraocular muscle enlargement may also aid diagnosis. Correction of thyroid dysfunction and supportive measures are necessary in all cases. Immunosuppression is reserved for moderate to severe active orbitopathy and rehabilitative surgery is generally used once the disease is quiescent. A good visual and cosmetic outcome requires close cooperation between the general practitioner, endocrinologist and ophthalmologist.

Female↗
PubMed2002

Orbital foreign body misdiagnosed as superior orbital rim fracture.

Orbital foreign bodies may be difficult to diagnose clinically and radiologically. In cases where a foreign body is suspected, both the mechanism of injury and the composition of the offending material need to be taken into account. A case is described of an orbital foreign body misdiagnosed as a superior orbital rim fracture, resulting in persistent ptosis and diplopia, and leading to delayed recovery for the patient, a commercial airline pilot.

Adult↗
PubMed2002

Orbital lipomatous haemangiopericytoma: an unusual variant.

Haemangiopericytoma (HPC) of the orbit is a rare tumour occurring in all age groups and presenting with slowly progressive proptosis, ocular motility impairment and visual loss. Although most are benign tumours that are resectable at diagnosis, one-third of these tumours demonstrate malignant features and recur locally or metastasize, usually with a fatal outcome. In 1995, a morphologically unique variant, termed lipomatous haemangiopericytoma (L-HPC), was described. Only one case has been reported previously arising in the orbit. In this paper, a case is reported of L-HPC occurring in the orbit and consider the prognostic implications of this HPC variant.

Aged↗
PubMedDate not supplied

Primary bone tumors of the orbit.

Primary tumors of orbital bone constitute 0.6% to 2% of all orbital tumors. Our experience over a 24-year period in the Orbital Clinic at the University of British Columbia yielded 62 (1.9%) cases from a total of 3,340 orbital tumors. Although a heterogeneous group, primary orbital bone tumors may be classified on a clinicopathologic basis into benign fibro-osseous or cartilaginous, reactive, neoplastic and vascular disorders. Presentation is usually a gradual mass effect, with infiltration and acute hemorrhage being features of malignant and reactive lesions respectively. The two most commonly encountered entities were fibrous dysplasia and osteoma, accounting for 22 cases. Although both these conditions rarely present a diagnostic challenge, nonspecific histologic and radiologic appearances can result in poor characterization of several of the rarer lesions. Hence, close cooperation between clinician, radiologist and pathologist is essential for accurate diagnosis.

Bone Neoplasms↗
PubMedDate not supplied

Optic neuropathy: puls/minus.

A 26-year-old Asian woman presented with bilateral disk swelling, retinal exudates and infarcts. Evaluation found the underlying cause of the hypertensive optic neuropathy to be renal artery stenosis due to Takayasu's arteritis.

Adult↗