Regarding invasion of the lacrimal system by basal cell carcinoma.
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Biomedical subjects
Publications and source records attributed to R S Rodriguez-Sains.
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Two hundred fifty-seven patients with biopsy-proven dysplastic nevus syndrome (DNS) were evaluated ophthalmologically and compared with 264 non-DNS patients, who acted as a control population. A statistically significant increase in the percentage of the DNS patients versus controls harboring conjunctival nevi (8.56% vs. 1.14%), iris nevi (24.90% vs. 9.47%), and choroidal nevi (14.40% vs. 5.30%) was encountered. The number of iris nevi found per patient was also greater statistically for the DNS group. Also encountered in the DNS group was presence of multiple nevus types in the same patient (iris and choroidal, iris and conjunctival, conjunctival and choroidal); 3 patients had all three nevus types present, and 4 patients had two choroidal nevi per eye. No patient in the control group had more than one nevus type present per eye.
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Basal cell carcinomas of the eyelids, especially those in the medial canthal area, may cause extensive local destruction. Recurrent tumours are more aggressive and become progressively more difficult to treat; this is especially true for postirradiated recurrent, medial canthal, basal cell carcinomas. Tumours in this area should thus be treated by a technique which allows tissue sampling in order to gauge the adequacy of the treatment, with the goal being complete extirpation of the tumour. Excision monitored by frozen section control or Mohs' surgery is our recommendation based on a retrospective analyses of 631 eyelid basal cell carcinomas, half of which were primary tumours and half recurrent.
Ninety-two patients with biopsy-proven dysplastic nevus syndrome were evaluated ophthalmologically and compared to a non-dysplastic nevus syndrome control population. A statistically significant increase in the percentage of dysplastic nevus syndrome patients versus controls harboring conjunctival nevi (9.78% vs. 1.85%), iris nevi (31.52% vs. 12.96%), and choroidal nevi (18.48% vs. 4.63%) was found. Although not statistically significant, the number of iris nevi encountered per patient was greater for the dysplastic nevus syndrome group. All dysplastic nevus syndrome patients and their families should be evaluated ophthalmologically, with special attention being given to dilated indirect ophthalmoscopy.
The importance of melanomas of the eye and adnexa is that they can be as deadly as the most aggressive cutaneous types, with 15-year mortality rates approaching 50 per cent. Also, treatment may permanently impair the sight. This discussion of melanomas that affect the eye and adnexa commences with the eyelids, proceeds to the conjunctiva, follows with the ocular globe, and includes a consideration of the dysplastic nevus syndrome as it affects the eye.
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An elderly patient with a large, acquired macular pigmented lesion on the skin of the left lateral canthus is described. Clinically, the lesion was consistent with lentigo maligna and total excision was performed. Histopathologic examination revealed atypically melanocytic proliferation at the dermal-epidermal junction without dermal invasion. The premalignant nature of this lesion is discussed as well as the clinical diagnostic clues. A brief review is given of the different types of cutaneous melanoma and prognostic factors, diagnosis, and management.
A 51-year-old white man had the B-K mole syndrome (multiple large atypical cutaneous nevi of the upper part of the trunk and extremities, inherited as an autosomal dominant trait, and thought to be more susceptible to malignant transformation), so named after two patients in whom the syndrome was first observed. Two cutaneous malignant melanomas (thigh and back) and an ocular malignant melanoma (ciliary body and iris) simultaneously developed. Patients with B-K mole syndrome have been known to have a very high risk for the development of cutaneous melanoma (including multiple primary cutaneous melanomas) and multiple primary malignancies. There may be a propensity in these patients for development of ocular melanomas.
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