Periorbital melasma: Hierarchical cluster analysis of clinical features in Asian patients.

BACKGROUND: Studies have shown melasma lesions to be distributed across the face in centrofacial, malar, and mandibular patterns. Meanwhile, however, melasma lesions of the periorbital area have yet to be thoroughly described. METHODS: We analyzed normal and ultraviolet light-exposed photographs of patients with melasma. The periorbital melasma lesions were measured according to anatomical reference points and a hierarchical cluster analysis was performed. RESULTS: The periorbital melasma lesions showed clinical features of fine and homogenous melasma pigmentation, involving both the upper and lower eyelids that extended to other anatomical sites with a darker and coarser appearance. The hierarchical cluster analysis indicated that patients with periorbital melasma can be categorized into two clusters according to the surface anatomy of the face. Significant differences between cluster 1 and cluster 2 were found in lateral distance and inferolateral distance, but not in medial distance and superior distance. Comparing the two clusters, patients in cluster 2 were found to be significantly older and more commonly accompanied by melasma lesions of the temple and medial cheek. CONCLUSION: Our hierarchical cluster analysis of periorbital melasma lesions demonstrated that Asian patients with periorbital melasma can be categorized into two clusters according to the surface anatomy of the face.

Sebaceous gland carcinoma of the eyelid: clinicopathological features and outcome in Asian Indians.

PURPOSE: To study the clinical and histopathological features of eyelid sebaceous gland carcinoma (SGC) and to evaluate the prognosis in the Asian-Indian population. METHODS: This is a retrospective study of 191 patients with SGC. RESULTS: The mean age at presentation of eyelid SGC was 57 years (median, 56 years). The tumor epicenter was most commonly located in the upper eyelid (n=125, 65%). The mean tumor basal diameter was 15 mm (median, 10 mm). There was evidence of tumor extension into the orbit (n=30, 16%), paranasal sinuses (n=3, 2%), and brain (n=1, 1%). Wide excision biopsy (n=146, 78%) was the most common treatment modality. Tumor recurrence was noted in 42 (24%) patients over a mean follow-up period of 29 months (median, 20 months). On the basis of the Kaplan-Meier estimate, lymph node metastasis occurred in 18%, systemic metastasis was detected in 10%, and death occurred in 2% of patients at 10 years. On multivariate analysis, the factors predicting locoregional lymph node and systemic metastasis were medial canthal involvement (P=0.004; P=0.013), lateral canthal involvement (P=0.013; P=0.025), tumor basal diameter >10 mm (P=0.002; P=0.002), and perivascular invasion (P=0.043; P<0.001), respectively. The factors predicting death due to metastasis on multivariate analysis were medial canthal involvement (P=0.012) and tumor basal diameter >10 mm (P=0.001). CONCLUSION: Advanced eyelid SGC is a tumor associated with poor prognosis. In this study, canthal involvement, larger tumor diameter, and perivascular invasion were poor prognostic factors.

[Epidemiological and clinical characteristics of primary ocular cancers in blacks: our experience with 111 cases]. / Aspects épidémiologiques et cliniques des cancers oculaires primitifs du mélanoderme : notre expérience à propos de 111 cas.

INTRODUCTION: In this work, the authors aim to study clinical and epidemiological characteristics of ocular and orbital primary cancers in sub-Saharan African. PATIENTS AND METHODS: This is a retrospective study over a period of 21 years, from 1984 to 2004, including all cases of ocular cancer, histologically proven after surgery of the globe or the orbit. For each patient, we studied the following parameters: age, sex, reason(s) for consultation, the affected eye, and histological result of the operative specimen. These data were collected by studying the departmental surgical registry, patient medical records and the tumor registry of the anatomicopathology laboratory of a tertiary care hospital in sub-Saharan Africa. RESULTS: We collected data on 111 black patients, among whom 15 cases (13.5%) presented with bilateral involvement, for a total of 126 eyes. The sex ratio was 1.17. Presenting signs showed a predominance of leukocoria (30.2%) followed by proptosis (21.7%) and in third place, protruding conjunctival mass (10.8%). Retinoblastoma was found most frequently, representing 66.6% of the oculo-orbital tumors and 95.45% of the tumors of the globe; followed by epidermoid carcinoma, representing 15.08% of cases. Malignant melanoma was third most common, representing 4.76%, with 83% arising in the anterior uvea and 7% in the choroid. Basal cell carcinoma and rhabdomyosarcoma follow in fourth place. Basal cell carcinoma constituted half (50%) of the eyelid tumors. Rhabdomyosarcoma was the most common orbital tumor in our series (57%). Next were lymphomas with conjunctival localization (2.38%), acute leukemia with orbital localization (1.59%) and rare tumors, palpebral dermatofibrosarcoma (0.79%), an orbital angiosarcoma (0.79%), a glioblastoma of the globe (0.79%) and a malignant solitary fibrous tumor of the orbit (0.79%). CONCLUSION: Ocular and orbital primary cancers in blacks remain tumors of the young, equally distributed between the sexes. Retinoblastoma is the most frequent, followed by epidermoid carcinoma. The globe is the preferential localization of these cancers.

Eccrine Porocarcinoma of the Eyelid in a Non-Caucasian Patient.

A 60-year-old lady of Chinese origin presented with a right medial canthal mass. The lesion had been present for many years but progressively increased in size a few months prior to the consultation. Clinical examination revealed a medial canthal mass measuring 1.8 cm in diameter. It was firm with an irregular crusting surface. It was not attached to underlying deep lamella, and there were overlying telangiectatic vessels with contact bleeding. Excisional biopsy of the lesion confirmed a diagnosis of eccrine porocarcinoma. Eccrine porocarcinoma rarely occurs in the eyelid, and this is the first reported case of its occurrence in non-Caucasian patient. Given the significant risk of recurrence and metastasis, long-term surveillance is warranted. Although being rare, ophthalmologists should be vigilant of this potentially life-threatening lesion in the management of eyelid tumors.

Lentigo maligna of the eyelid a rare finding in African Americans.

OBJECTIVE: To report the case of a 48-year-old African American man with lentigo maligna of the left lower eyelid. DESIGN: Interventional case report. PARTICIPANTS: One patient with lentigo maligna of the left lower eyelid. METHODS: We report the clinical presentation, histopathologic and immunohistochemical features, and treatment of an African American man with lentigo maligna of the eyelid. The current literature regarding this uncommon neoplasm in African American patients also is reviewed. MAIN OUTCOME MEASURES: Histopathologic and immunohistochemical diagnosis and clinical evaluation for recurrence. RESULTS: An excisional biopsy revealed lentigo maligna. An extensive literature search revealed no definitive reports of lentigo maligna or lentigo maligna melanoma of the eyelid in an African American patient. CONCLUSIONS: Although extremely rare, lentigo maligna may involve ocular adnexal skin in African Americans. Awareness and recognition of this premalignant lesion will aid in early diagnosis and treatment and eventually may improve prognosis.

Caruncular malignant melanoma in a black patient.

An 84-year-old black woman had a right caruncular lesion that had progressively enlarged over the past 3 months. Surgical excision and cryotherapy were performed. A biopsy confirmed the diagnosis of caruncular malignant melanoma, a rare lesion which, to our knowledge, has not been previously reported in a black patient.