Faculty Bibliography

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

Cure rates for 631 periocular basal cell carcinomas treated by Mohs surgery proved to be 98.1% for primary lesions and 93.6% for previously treated lesions. All recurrences of primary lesions post-Mohs surgery were located in the medial canthus. Among lesions previously treated, recurrence rates after Mohs surgery were twice as high for medial canthal lesions as for other periocular basal cell carcinomas, 9.5 and 4.5%, respectively. A threefold increased risk of recurrence was observed for medial canthal lesions (post-Mohs surgery) previously treated by radiation as compared to all other treatment modalities. This high recurrence rate may reflect past practices of treating large medial canthal basal cell carcinomas with radiation rather than by other means. Results of our study indicate that primary basal cell carcinomas in the medial canthus can be treated by microscopically controlled excision with excellent results

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

Sebaceous carcinomas are rare, and deadly, adnexal tumors with a distinct predilection for eyelid skin. A chronic blepharoconjunctivitis and/or a recurrent chalazion are the most common clinical presentations that should alert the clinician to the diagnosis. Great care and skill are needed in interpreting these lesions histopathologically as they can be easily confused with basal- and squamous-cell carcinomas

The variety of lesions that can cause alopecia of the eyelashes (Table 1) demonstrates the need for accurate diagnosis. A full-thickness biopsy of lid margin with appropriate three-suture closure can leave an imperceptible defect and may provide invaluable information. Although a partial-thickness lid biopsy is certainly appropriate for many common eyelid tumors such as basal-cell carcinomas or nevi, we feel strongly that a full-thickness lid biopsy is indicated when discussing chronic eyelid lesions that cause alopecia. The information gathered from a full-thickness biopsy is far superior especially in those lesions which cause chronic blepharitis or especially in a case of a recurrent chalazion where the conjunctival surface and skin surface are both equally significant. The high mortality associated with sebaceous-cell carcinomas makes a good pathologic specimen allowing for accurate diagnosis essential. Partial-thickness eyelid biopsies, especially in cases of sebaceous carcinoma, may lead the pathologist to an erroneous, more benign, diagnosis and the clinician to a false sense of security. While many of the nonscarring alopecias may be diagnosed on their clinical characteristics alone, the scarring alopecias will frequently need a lid biopsy to ascertain diagnosis and gauge treatment