109a - oculoplasticscase study #1 ocular surface squamous neoplasia (ossn) •patient: 72 year old...

11/10/2015

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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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• 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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Nursing Considerations

• Locating a compounding pharmacy

• Instructions on how to receive the chemotherapy

• Instructions on administering the ophthalmic drops

• Surveillance

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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 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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• 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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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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• Lubrication

• Surveillance

• Timely feedback on imaging studies

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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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• 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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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 ConjunctivaCutler Beard Procedure

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• 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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109a - oculoplasticscase study #1 ocular surface squamous neoplasia (ossn) •patient: 72 year old...

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