Basalioma of the century

Basal cell carcinoma (basal cell) of the century is the most common malignant disease, which most often affects elderly patients. Important risk factors are light, sunless skin and chronic insolation. In 10% of cases, the formation is localized on the head and neck, in 10% the eyelid is affected.

Insufficiently complete treatment makes tumors more aggressive with the flow and difficult to treat.

[1], [2], [3], [4], [5], [6], [7], [8], [9], [10],

Causes of the basal cell

One of the following diseases in young patients can lead to the development of the basal cell of the eyelid.

Pigment xeroderma is an autosomal recessive disease characterized by progressive skin dyspigmentation as a result of insolation. Patients differ in a characteristic bird-like appearance of the face, tend to develop basal cell carcinoma, squamous cell carcinoma and melapoma, often multiple. In addition, they have described malignant neoplasms of the conjunctiva.

Gorlin-Goltz syndrome (non -oid-basal cell carcinoma syndrome) is a rare autosomal dominant disease characterized by severe malformations of the eyes, face, bones and CNS. Many patients develop multiple, small basaliomas during 2 decades of life. In addition, there is a predisposition to other malignant neoplasms, including medulloblastoma, breast carcinoma and Hodgkin lymphoma.

[11]

Symptoms of the basal cell

Basalioma is the most frequent malignant tumor of the century, it accounts for 90% of all neoplasms. As a rule, the lower eyelid is affected. Zones of damage (decreasing in frequency): medial adhesion of the eyelids, upper eyelid and external adhesion of the eyelids. The tumor is characterized by a slow invasive growth without metastasis. Tumors located near the internal adhesion of the eyelids, more often penetrate into the orbit and sinuses and, but compared with tumors of other localization, difficult to treat and are prone to relapse.

Ultrasonic-ulcer form is a brilliant pearly node with small telangiectasies on the surface. In the initial period, the basal cell grows slowly, within 1-2 years the tumor reaches a size of 0.5 cm in diameter. If the tumor is not recognized and not cured at an early stage, with further rapid growth in its center, there is ulceration with falciform edges and dilated blood vessels but laterally ("eradicated" ulcer). Over time, it can destroy much of the century.

Sclerosing form is less common and rather difficult to diagnose, because the tumor sprouts from under the epidermis in the form of a solid plaque, deforming the eyelid. The edges of the tumor are indistinct, the palpatorio is defined much larger than in a visual examination. With a superficial examination, the sclera-like form of basal cell can be taken as local chronic blepharitis.

[12], [13], [14]

Treatment of the basal cell

It is recommended to completely remove the tumor with the maximum preservation of healthy tissues. When a small basal cell is removed, the tumor is resected within 4 mm of healthy tissues. With large size and aggressiveness, a basal type of SCC and CSF requires a significant amount of radical surgical intervention. In this case, the control of the frozen cut is used by a standard method or by micrographic surgery, which increases the success of the operation.

The standard method for controlling the frozen cut is to conduct a histological examination of the edges of the excised lesion during surgery to ensure complete removal of the tumor tissue. If tumor cells are not detected in the cut, a century reconstruction is performed; in the presence of tumor cells, additional excision of the formation is performed.

Micrographic surgery on Moh - removal with a series of frost horizontal slices under the base of the tumor. Sections are coded with colors or schematically to identify undeveloped areas of the tumor. Despite the duration, the study increases the guarantee of complete excision of the tumor with maximum preservation of healthy tissues. This technique is especially useful in cases of tumors with hard-to-define boundaries or finger-shaped outgrowths on the edges of the tumor, such as sclerosing forms of basal cell carcinoma, CSF, recurrent tumors or tumors located in the area of the eyelid adhesions.

Technique of reconstruction

The choice of technique depends on the degree of horizontal resection, the size of the defect and the weakness of the eyelid. An important point is the restoration of the anterior and posterior plates of the century. If one of the plates was damaged during the removal of the tumor, it should be restored with a similar tissue.

1. Small defects occupying less than 1/3 of a century are usually sutured if the surrounding tissues are sufficiently elastic for repositioning the edges of the wound. If necessary lateral cantolysis can be reconstructed with the help of additional tissue in case the defect can not be bruised.
2. Small defects occupying less than 1/2 century are sewn using a semicircular skin flap of Tenzel.
3. Large defects occupying more than 1/2 century can be restored by applying one of the following methods.
   • The Mustarde technique (taking a skin flap from the cheek) is used to close the defect of the lower eyelid. The posterior plate is restored with the cartilage and mucosa of the nasal septum or with the mucosa of the cheek of the required thickness, or with a Hughes flap;
   • the technique of separation of the century can also be used, but with caution. When restoring the lower eyelid, the complete preservation of the function of the upper eyelid is necessary.
   • the method of a diamond-shaped flap from the area of the eyebrow is used to close defects located in the medial corner of the eye gap and the middle color of the upper eyelid.

Indications for radiation therapy in the basalioma of the century:

• Small nodular-sciatic basioliomas of the medial angle of the optic gap in patients who are not shown surgery, or in the event of patient's refusal from surgery.
• Kaposi's Sarcoma.

Contraindications to radiotherapy for basaliomas of the century

• Basal correction of the medial angle of the eye gap, since damage to the radiotherapy of lacrimal ducts causes lacrimation.
• Tumors of the edge of the upper eyelid, as the subsequent keratosis causes discomfort.