109A - OculoplasticsCASE STUDY #1 Ocular Surface Squamous Neoplasia (OSSN) •Patient: 72 year old...
Transcript of 109A - OculoplasticsCASE STUDY #1 Ocular Surface Squamous Neoplasia (OSSN) •Patient: 72 year old...
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Case Studies in Oculoplastics with Nursing Considerations
Gail G. Morrell, MSN, FNP‐BC, CRNO, COMTNovember 13, 2015
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Disclosure
I have no relevant financial or nonfinancial relationships to disclose related to this presentation.
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CASE STUDY #1
Ocular Surface Squamous Neoplasia (OSSN)
• Patient: 72 year old male presented with a recurrent lesion at the right limbus with extension onto the cornea
• Biopsy of the conjunctiva at the right limbus demonstrated squamous cell carcinoma
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Conjunctival Squamous Carcinoma
• Conjunctival squamous carcinomas are generally located at the limbus and have a flesh‐like elevation
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Conjunctival Squamous Carcinoma
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Conjunctival Squamous Carcinoma
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Conjunctival Squamous Carcinoma
• These lesions are usually treated with surgical excision and cryotherapy to the surgical margins
• If there is diffuse surface involvement or local recurrence, the carcinoma may be treated with adjunct topical chemotherapy such as Mitomycin‐C, 5‐Fluorouracil, or Interferon
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Conjunctival Squamous Carcinoma
Nursing Considerations
• Locating a compounding pharmacy
• Instructions on how to receive the chemotherapy
• Instructions on administering the ophthalmic drops
• Surveillance
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Conjunctival Squamous Carcinoma
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CASE STUDY #2
Adenoid Cystic Carcinoma of the Lacrimal Gland
• Patient: 35 year old male presented with a history of periorbital spasms, numbness and tingling on his scalp, and headaches
• Biopsy of the lacrimal gland demonstrated adenoid cystic carcinoma, tubular and cribriform pattern
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Adenoid Cystic Carcinoma of the Lacrimal Gland
• Adenoid cystic carcinoma of the lacrimal gland is the most common primary malignant epithelial tumor of the lacrimal gland
• Clinical history and presentation may include a palpable mass in the superior lateral quadrant, with associated pain and proptosis directed inferomedially
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Adenoid Cystic Carcinoma of the Lacrimal Gland
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Adenoid Cystic Carcinoma of the Lacrimal Gland
• There are five histological subtypes of adenoid cystic carcinoma
• Cribriform and tubular are associated with a more favorable prognosis
• Solid (basaloid) is associated with the worst prognosis
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Adenoid Cystic Carcinoma of the Lacrimal Gland
Treatments
• The most common surgical treatment is orbital exenteration followed by postoperative radiation treatment
• At my institution, if there is no metastatic disease, consideration is given to complete surgical excision of the tumor followed by radio/chemotherapy
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Adenoid Cystic Carcinoma of the Lacrimal Gland
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Adenoid Cystic Carcinoma of the Lacrimal Gland
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Adenoid Cystic Carcinoma of the Lacrimal Gland
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Adenoid Cystic Carcinoma of the Lacrimal Gland
Nursing Considerations
• Lubrication
• Surveillance
• Timely feedback on imaging studies
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Adenoid Cystic Carcinoma of the Lacrimal Gland
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Adenoid Cystic Carcinoma of the Lacrimal Gland
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CASE STUDY #3
Malignant Melanoma of the Conjunctiva
• Patient: 41 year old female presented with a previously excised invasive melanoma of the bulbar conjunctiva
• On examination, she was found to have extensive melanoma of the left upper palpebral and tarsal conjunctiva
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Malignant Melanoma of the Conjunctiva
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Malignant Melanoma of the Conjunctiva
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Malignant Melanoma of the Conjunctiva
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Malignant Melanoma of the Conjunctiva
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Malignant Melanoma of the Conjunctiva
• Conjuctival melanoma accounts for 2‐5% of ocular malignant melanomas
• It is rare
• It usually affects one eye and is usually pigmented
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Malignant Melanoma of the Conjunctiva
Treatments
• Surgical excision with the margins as wide as possible and cryotherapy to the surgical margins
• Reconstruction of the defect
• This patient had what is called a Cutler Beard flap
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Malignant Melanoma of the Conjunctiva
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Malignant Melanoma of the Conjunctiva
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Malignant Melanoma of the ConjunctivaCutler Beard Procedure
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Malignant Melanoma of the Conjunctiva
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Malignant Melanoma of the Conjunctiva
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Malignant Melanoma of the Conjunctiva
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Malignant Melanoma of the Conjunctiva
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Malignant Melanoma of the Conjunctiva
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Malignant Melanoma of the Conjunctiva
Nursing Considerations
• Bandage contact lens
• Teach the patient how to take lens in and out
• Continuous wear
• Surveillance
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Reference ListAdler, E., Turner, J.R., & Stone, D.U. (2013). Ocular surface squamous neoplasia: A survey of changes in the standard of care from
2003 to 2012. Clinical Science, 32, 1558‐1561.
Ahmad, S.M., Esmaeli, B., Williams, M., Nguyen, J., Fay, A., Woog, J., . . . Lopez, A. (2009). American Joint Committee on Cancer Classification predicts outcome of patients with lacrimal gland adenoid cystic carcinoma. Ophthalmology, 116, 1210‐1215. doi:10.1016/j.ophtha.2008.12.049
Aristodemou, P. (2010). Letter to the editor regarding 2009 lacrimal gland adenoid cystic carcinoma article by Ahmad, et al. Ophthalmology 117, 196.
Bell, D., Sniegowski, M.C., Wani, K., Prieto, V., & Esmaeli, B. (2015). Mutational landscape of lacrimal gland carcinomas andimplications for treatment. Head & Neck. Advance online publication. doi:10.1002/hed.24078
Besley, J., Pappalardo, J., Lee, G.A., Hirst, L.W., & Vincent S.J. (2014). Risk factors for ocular surface squamous neoplasia recurrence after treatment with topical Mitomycin C and Interferon Alpha‐2b. American Journal of Ophthalmology, 157, 287‐293. doi.org/10.1016/j.ajo.2013.10.012
Brownstein, S. (2004). Malignant melanoma of the conjunctiva. Cancer Control, 11, 310‐316.
Chawla, B., Kashyap, S., Sen, S., Bajaj, M.S., Pushker, N., Gupta, K., . . . Ghose, S. (2013). Clinicopathologic review of epithelial tumors of the lacrimal gland. Ophthalmic Plastic and Reconstructive Surgery, 29, 440‐445. doi:10.1097/IOP.0b013e31829f3a0c
Cook, B.E., & Bartley, G.B. (2001). Treatment options and future prospects for the management of eyelid malignancies. Ophthalmology, 108, 2088‐2098.
Esmaeli, B. (ed.). (2011). Ophthalmic oncology. New York, NY: Springer.
Esmaeli, B. (2010). Response to the letter to the editor by P. Aristodemou. Ophthalmology, 117, 196.
Esmaeli, B., Nasser, Q.J., Cruz, H., Fellman, M., Warneke, C.L., & Ivan, D. (2012). American Joint Committee on cancer T category for eyelid sebaceous carcinoma correlates with nodal metastasis and survival. Ophthalmology, 119, 1078‐1082. doi:10.1016/j.ophtha.2011.11.006
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Reference ListKim, H.J., Shields, C.L., Shah, S.U., Kaliki, S., & Lally, S.E. (2012). Giant ocular surface squamous neoplasia managed with Interferon
Alpha‐2b as immunotherapy or immunoreduction. Ophthalmology, 119, 938‐944. doi:10.1016/j.ophtha.2011.11.035
Mendoza, P.R., & Grossniklaus, H.E. (2015). Sentinel lymph node biopsy for eyelid and conjunctival tumors: What is the evidence?International Ophthalmology Clinics, 55, 123‐136.
Nanji, A.A., Moon, C.S., Galor, A., Sein, J., Oellers, P., & Karp, C.L. (2014). Surgical versus medical treatment of ocular surface squamous neoplasia: A comparison of recurrences and complications. Ophthalmology, 121, 994‐1000. doi.org/10.1016/j.ophtha.2013.11.017
Nanji, A.A., Sayyad, F.E., & Karp, C.L. (2013). Topical chemotherapy for ocular surface squamous neoplasia. Current Opin Ophthalmology, 24, 336‐342. doi:10.1097/ICU.0b013e3283622a13
Pe’er, J., & Singh, A.D. (eds.). (2014). Clinical ophthalmic oncology (2nd ed.). New York, NY: Springer.
Pfeiffer, M.L., Savar, A., & Esmaeli, B. (2013). Sentinel lymph node biopsy for eyelid and conjunctival tumors: What have we learned in the past decade? Ophthalmic Plastic and Reconstructive Surgery, 29, 57‐62. doi:10.1097/IOP.0b013e31827472c5
Shields, J.A., Demirci, H., Marr, B.P., Eagle, R.C., & Shields, C.L. (2004). Sebaceous carcinoma of the eyelids: Personal experiencewith 60 cases. Ophthalmology, 111, 2151‐2157. doi:10.1016/j.ophtha.2004.07.031
Shields, J.A., Demirci, H., Marr, B.P., Eagle, R.C., & Shields, C.L. (2005). Sebaceous carcinoma of the ocular region: A review. Survey of Ophthalmology, 50, 103‐122. doi:10.1016/j.survophthal.2004.12.008
Shinder, R., Al‐Zubidi, N., & Esmaeli, B. (2011). Survey of orbital tumors at a comprehensive cancer center in the United States. Head & Neck. Online publication. doi:10.1002/hed.21498
Slutsky, J.B., & Jones, E.C. (2012). Periocular cutaneous malignancies: A review of the literature. Dermatologic Surgery, 38, 552‐569. doi:10.1111/j.1524‐4725.2012.02367.x
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Contact Information
Gail G. Morrell
MD Anderson, University of Texas Cancer Center
Telephone: 713‐745‐1047
Email: [email protected]
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