By Paul T. Finger, MD

Note the large nodular basal cell carcinoma on the right lower eye lid and cheek in the image below. It has pulled the eye lid out (cicatricial ectropion) and was found to invade the orbit on CT scan. Click on an image below to enlarge and see the full description:

The diagnosis was easily confirmed by taking a small wedge biopsy in the office. Then after a complete discussion of treatment options, this patient opted for intravenous chemotherapy rather than extensive surgery or radiation therapy. In this case, 3 courses of cis-platinum chemotherapy reduced the size of the tumor. Due to renal toxicity, the treatment was discontinued. Chemoreduction did not (in itself) cure this patient, but it did allow for local resection of the reduced sized-tumor. Under frozen section control, tumor-free margins were obtained.

For more information on the investigational technique we offer the following references.

References

1. Luxenberg MN and Guthrie TH, Jr.. Chemotherapy of eyelid and periorbital tumors. Trans Am Ophthal Soc 1985;83:162-180.

   

2. Luxenberg MN and Guthrie TH, Jr.. Chemotherapy of basal cell and squamous cell carcinoma of the eyelids and periorbital tumors. Ophthalmology 1996;93:504-510.
3. Morley M, Finger PT, Perlin M, Weiselberg LR, DeBlasio DS. Cis-Platinum Chemotherapy for Ocular Basal Cell Carcinoma. The British Journal of Ophthalmology, 1991, 75, 407-410.

Related Links

• Search PubMed for Chemoreduction of Orbital Tumors
• Search Google for Chemoreduction of Orbital Tumors

By Paul T. Finger, MD

Dr. Finger uses laser photocoagulation to prevent radiation related retinopathy, maculopathy, and loss of vision. As published in the British Journal of Ophthalmology, Drs. Finger and Kurli found that eyes with posterior choroidal melanomas were more likely to develop sight-threatening radiation retinopathy. In that series, 50 patients were treated with sector scatter laser photocoagulation to clinically evident radiation retinopathy. A second group of patients (considered to be “high risk” to develop radiation retinopathy) were also treated with laser.

In this study, laser photocoagulation improved radiation retinopathy in 29 (64.4%) of the 45 patients treated after the onset of radiation retinopathy (17 with only retinopathy, 10 with a combination of retinopathy and maculopathy, and two with only maculopathy). Of the 16 patients who received laser treatment before clinical evidence of retinopathy, only 1 developed radiation maculopathy and two retinopathy without maculopathy (all three responded to additional laser photocoagulation).
None of the patients in the prophylactic laser group lost more than three lines of vision as a result of maculopathy.

Conclusions

Sector scatter argon laser photocoagulation can be used to induce regression of radiation retinopathy. Though early treatment of radiation retinopathy appears to be more effective, a more long term and prospective randomized study should be performed.

Related Links

• Read the article from the British Journal of Ophthalmology
• Read and view the “Finger Classification of Radiation Retinopathy”
• Search PubMed for Laser photocoagulation for radiation retinopathy
• Search Google for Laser photocoagulation for radiation retinopathy

By Paul T. Finger, MD

In a research study, Dr. Finger compared the intensity of radioactive glucose uptake [from positron emmission tomography (PET)] to clinical, ultrasound, and pathology features of choroidal melanomas evaluated by FDG positron emission tomography / computed tomography (PET/CT). Ultrasound was used to measure tumor size, evaluate tumor shape and intrinsic vascularity (blood flow). Histopathology and immunohistochemical evaluations of tumor cell-type, necrosis, glycogen-content, vascularity and extrascleral extension were performed.

Selecting out the highest 6 PET/CT standardized uptake values [(SUV) > or = to 4.0] melanomas, patients were (on average) 10 years older. in general, higher SUV tumors had larger basal dimensions, were epithelioid-cell type, were centered anterior to the equator, contained enlarged blood vessels (>150 microns in diameter), and had formed extrascleral extension.

This study suggests that PET/CT imaging offered a physiologic assessment of glucose metabolism within choroidal melanomas. Increased FDG PET/CT SUV ( > or = to 4.0) was positively correlated to known clinical, pathology, and ultrasound features linked to metastatic potential of choroidal melanoma.

Related Links

• View this innovation as it appears in the British Journal of Ophthalmology
• An article that demonstrates how tumor size is correlated to PET/CT SUV
• An article that demonstrates the use of PET/CT for initial screening of patients with choroidal melanoma.
• An article that demonstrates the sites of choroidal melanoma metastasis defined by PET/CT
• Search PubMed for 18FDG PET/CT SUV: A Noninvasive Biomarker For the Risk of Metastasis from Choroidal Melanoma
• Search Google for 18FDG PET/CT SUV: A Noninvasive Biomarker For the Risk of Metastasis from Choroidal Melanoma