| Identifier |
skin_cancers_in_neuro_ophthalmology_lee |
| Title |
Skin Cancers in Neuro-Ophthalmology |
| Creator |
Andrew G. Lee, MD; Sami Younes |
| Affiliation |
(AGL) Chairman, Department of Ophthalmology, The Methodist Hospital, Houston, Texas; Professor of Ophthalmology, Weill Cornell Medicine, New York City, New York; (SY) Class of 2022, Baylor College of Medicine, Houston, Texas |
| Subject |
Cancer; Melanoma; Malignant Melanoma |
| Description |
Summary: 1. Malignant melanoma metastasis can affect the eye and orbital region a. Level of depth is most important factor 2. Basal and squamous cell carcinomas are the most common skin cancers a. Both have predilection for the head and neck i. Perineural spread is the concern when the cancer occurs in close proximity to the lid, V1, and V2 distributions b. Basal cell carcinoma doesn't metastasize but squamous cell carcinoma does 3. Basosquamous is a more aggressive form of basal and squamous cell carcinomas a. High chance of perineural spread (i.e. orbital apex syndrome, optic neuropathy, ophthalmoplegia) 4. Skin cancer workup -> identify type of cancer, location, and affected ophthalmological pathway depending on quality of symptoms |
| Transcript |
So today we're going to talk about why an ophthalmologist but in particular a neuro ophthalmologist needs to know a little bit about skin cancer. And of course the one we're most afraid of is malignant melanoma because malignant melanoma can metastasize, and it can recur even years after a gross total resection, and so we'd like to know some stuff about the melanoma, which is the depth. So what lies beneath is way more important than what lies on the surface. It is that depth that usually is predictive of the development of metastatic disease later. Different stagings with the depth, Clark and Breslow depending on what you're interested in, what your training is. Really what we're interested though is in the depth and that thing determines what the risk of melanoma metastatic disease is. So anybody who's coming to neuro ophth clinic who has a history of melanoma, it is the melanoma until proven otherwise. This is Lee's rule of cancer. However, most skin cancer is not melanoma. Most of the skin cancers are basal cell carcinoma, and these have predilection for the head and neck. And so we might see a patient with this and the closer it's getting to the lid and to the v1 or v2 distribution, the more likely you have to worry about perineural spread, the spread of that tumor along the nerve, the trigeminal nerve, either of them being subdivision one or two. Squamous cell carcinoma is more likely to spread. Basal cell usually does not metastasize, probably less than 1%, probably a lot less than 1% in fact. But squamous cell can metastasize. Most of the tumors thankfully are basal cell carcinoma and not squamous cell. The one I want to talk to you about now though is basosquamous, and it's kind of a combination of the basal and the squamous, and the reason you need to know it is, this basosquamous form is much more aggressive and much more likely to metastasize, maybe like 8 or 9 percent chance of getting a metastasis from the skin cancer, which is not the thing you're worried about here and perineural spread and that means it could show up to us as orbital apex syndrome, optic neuropathy, or ophthalmoplegia from direct extension along the trigeminal nerve right into the cavernous sinus. So any tumor of the skin that's near the eye, we'd like to know was it melanoma, basal cell, squamous cell, or basosquamous? Melanoma, it doesn't matter where it is. It can show up as a metastasis, but these three, it kind of matters where it is, so we'd like to have it on the ipsilateral side to the neuron problem. And if it's on the afferent side, optic neuropathy, orbital apex. If it's on the efferent side, orbital apex and cavernous sinus. And the path that you need to be worried about the most is basosquamous. |
| Date |
2021-04 |
| Language |
eng |
| Format |
video/mp4 |
| Type |
Image/MovingImage |
| Collection |
Neuro-Ophthalmology Virtual Education Library: Andrew G. Lee Collection: https://novel.utah.edu/Lee/ |
| Publisher |
North American Neuro-Ophthalmology Society |
| Holding Institution |
Spencer S. Eccles Health Sciences Library, University of Utah |
| Rights Management |
Copyright 2019. For further information regarding the rights to this collection, please visit: https://NOVEL.utah.edu/about/copyright |
| ARK |
ark:/87278/s6131q72 |
| Setname |
ehsl_novel_lee |
| ID |
1680627 |
| Reference URL |
https://collections.lib.utah.edu/ark:/87278/s6131q72 |
