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Diagnosis and treatment of malignant eyelid tumors

Diagnose und Therapie der malignen Lidtumoren. Englische Version

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The Original Article was published on 09 February 2023

Abstract

Background

Malignant tumors of the eyelid are much less frequent than benign eyelid alterations. These are frequently incidental findings without symptoms which are often overlooked or misinterpreted by patients.

Objective

This article gives an overview of clinical aspects, diagnostics and treatment of the five most common malignant eyelid tumors and exemplarily explains the essential principles of evidence-based treatment of malignant eyelid tumors.

Methods

This narrative review was prepared based on a selective literature search. The depiction of the treatment of eyelid tumors is supported by illustrations of clinical cases.

Results

The medical history and inspection provide initial indications of malignancy. Every eyelid change suspected of being malignant should be examined histologically to confirm a diagnosis. By far the most common malignant eyelid tumor in Europe is basal cell carcinoma, which metastasizes only in exceptional cases. Squamous cell carcinomas, sebaceous adenocarcinomas, melanomas and Merkel cell carcinomas occur much less frequently. In these cases, potential metastasis in particular must be considered when making the diagnosis and staging has to be initiated. Surgical excision into healthy tissue with tumor-free margins is the gold standard for malignant eyelid tumors. Non-surgical adjuvant or neoadjuvant forms of evidence-based treatment can be initiated based on the individual case to minimize the risk of recurrence and metastasis.

Conclusion

It is essential to recognize eyelid changes at an early stage, to classify them correctly and to initiate the appropriate treatment. The interaction between the general condition and the personal needs of a patient as well as state of the art medicine are the keys to a good personalized treatment.

Zusammenfassung

Hintergrund

Maligne Tumoren des Augenlids sind deutlich seltener als benigne Lidveränderungen. Häufig handelt es sich um symptomlose Zufallsbefunde, die Patient:innen vielfach übersehen bzw. falsch einschätzen.

Ziel

Diese Arbeit gibt eine Übersicht über die Klinik, Diagnostik und Therapie der 5 häufigsten malignen Lidtumoren und erklärt so exemplarisch die wesentlichen Prinzipien einer evidenzbasierten Versorgung von malignen Tumoren.

Methoden

Die Erstellung des narrativen Reviews erfolgte auf Basis einer selektiven Literaturrecherche. Die Darstellung der Lidtumorversorgung wurde mit Abbildungen von klinischen Fällen unterstützt.

Ergebnisse

Die Anamnese und Inspektion liefern erste Hinweise auf Malignität. Jede malignitätsverdächtige Lidveränderung sollte histologisch untersucht werden, um eine Diagnose zu sichern. Der mit Abstand häufigste maligne Lidtumor in Europa ist das Basalzellkarzinom, das nur in Ausnahmefällen metastasiert. Deutlich seltener treten das Plattenepithelkarzinom, das Talgdrüsenkarzinom, das Melanom und das Merkel-Zell-Karzinom auf. Bei diesen ist bei Diagnosestellung insbesondere die potenzielle Metastasierung zu bedenken und ein Staging einzuleiten. Für die malignen Lidtumoren stellt die chirurgische Exzision im Gesunden den Goldstandard dar. Nichtchirurgische Therapieformen können auf Basis einer evidenzbasierten Versorgung adjuvant oder neoadjuvant zum Einsatz kommen und so das Rezidiv- und Metastasierungsrisiko minimieren.

Schlussfolgerung

Es ist essenziell, Lidveränderungen frühzeitig zu erkennen, korrekt einzuordnen und adäquat zu therapieren. Gerade das Zusammenspiel zwischen dem Allgemeinzustand und den persönlichen Bedürfnissen einer Patient:in sowie der State-of-the-Art-Medizin ist Schlüssel einer guten personalisierten Versorgung.

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Authors and Affiliations

  1. Klinik für Augenheilkunde, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany

    S. Gniesmer, S. R. Sonntag, C. Schiemenz, M. Ranjbar, S. Grisanti & V. Kakkassery

  2. Zentrum für Augenheilkunde, Medizinische Fakultät und Universitätsklinikum Köln, Universität zu Köln, Köln, Germany

    L. M. Heindl

  3. Centrum für Integrierte Onkologie (CIO) Aachen-Bonn-Köln-Düsseldorf, Köln, Germany

    L. M. Heindl

  4. Augenklinik, Kantonsspital St. Gallen, St. Gallen, Switzerland

    M. A. Varde

  5. Augenklinik Universitätsspital Zürich, Zürich, Switzerland

    M. A. Varde

  6. Klinik und Poliklinik für Dermatologie und Venerologie, Universitätsmedizin Rostock, Rostock, Germany

    S. Emmert

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Correspondence to S. Gniesmer.

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Conflict of interest

S. Gniesmer, S.R. Sonntag, C. Schiemenz, M. Ranjbar, L.M. Heindl, M.A. Varde, S. Emmert, S. Grisanti, and V. Kakkassery declare that they have no competing interests.

For this article no studies with human participants or animals were performed by any of the authors. All studies mentioned were conducted in accordance with the ethical standards indicated in each case. Written consent has been obtained from patients and/or their legal representatives for images or other information within the manuscript by which patients can be identified.

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Gniesmer, S., Sonntag, S.R., Schiemenz, C. et al. Diagnosis and treatment of malignant eyelid tumors. Ophthalmologie 121 (Suppl 1), 33–39 (2024). https://doi.org/10.1007/s00347-023-01945-y

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