This article represents a planned regular updating of the previous British Association of Dermatologists guidelines for the management of basal cell carcinoma. These guidelines present evidence-based guidance for treatment, with identification of the strength of evidence available at the time of preparation of the guidelines, and a brief overview of epidemiological aspects, diagnosis and investigation.

https://www.bad.org.uk/library-media/documents/BCC_2008.pdf

Guidelines for the management of basal cell carcinoma

The appropriate use criteria process synthesizes evidence-based medicine, clinical practice experience, and expert judgment. The American Academy of Dermatology in collaboration with the American College of Mohs Surgery, the American Society for Dermatologic Surgery Association, and the American Society for Mohs Surgery has developed appropriate use criteria for 270 scenarios for which Mohs micrographic surgery (MMS) is frequently considered based on tumor and patient characteristics. This document reflects the rating of appropriateness of MMS for each of these clinical scenarios by a ratings panel in a process based on the appropriateness method developed by the RAND Corp (Santa Monica, CA)/University of California–Los Angeles (RAND/UCLA). At the conclusion of the rating process, consensus was reached for all 270 (100%) scenarios by the Ratings Panel, with 200 (74.07%) deemed as appropriate, 24 (8.89%) as uncertain, and 46 (17.04%) as inappropriate. For the 69 basal cell carcinoma scenarios, 53 were deemed appropriate, 6 uncertain, and 10 inappropriate. For the 143 squamous cell carcinoma scenarios, 102 were deemed appropriate, 7 uncertain, and 34 inappropriate. For the 12 lentigo maligna and melanoma in situ scenarios, 10 were deemed appropriate, 2 uncertain, and 0 inappropriate. For the 46 rare cutaneous malignancies scenarios, 35 were deemed appropriate, 9 uncertain, and 2 inappropriate. These appropriate use criteria have the potential to impact health care delivery, reimbursement policy, and physician decision making on patient selection for MMS, and aim to optimize the use of MMS for scenarios in which the expected clinical benefit is anticipated to be the greatest. In addition, recognition of those scenarios rated as uncertain facilitates an understanding of areas that would benefit from further research. Each clinical scenario identified in this document is crafted for the average patient and not the exception. Thus, the ultimate decision regarding the appropriateness of MMS should be determined by the expertise and clinical experience of the physician.

https://www.jaad.org/article/S0190-9622(12)00667-6/pdf

AAD/ACMS/ASDSA/ASMS 2012 appropriate use criteria for Mohs micrographic surgery: a report of the American Academy of Dermatology, American College of Mohs Surgery, American Society for Dermatologic Surgery Association, and the American Society for Mohs Surgery

These guidelines on the management of basal cell carcinoma have been prepared for dermatologists on behalf of the British Association of Dermatologists. They present evidence-based guidance for treatment, with identification of the strength of evidence available at the time of preparation of the guidelines, and a brief overview of epidemiological aspects, diagnosis and investigation.

Guidelines for the management of basal cell carcinoma. British Association of Dermatologists.

Epidemiologic characteristics and clinical course of patients with malignant eyelid tumors in an incidence cohort in Olmsted County, Minnesota.

https://www.hhcl.org.br/upload/artigoveronica1.pdf

The use of vital dyes in ocular surgery.

Management of periocular basal cell carcinoma: Mohs' micrographic surgery versus radiotherapy

Background/aims To clarify the pathogenesis of fibrosis in inflammatory orbital diseases, we analysed the gene expression in orbital biopsies and compared our results with those reported for idiopathic pulmonary fibrosis. Methods We collected 140 biopsies from 138 patients (58 lacrimal glands; 82 orbital fat). Diagnoses included healthy controls (n=27), non-specific orbital inflammation (NSOI) (n=61), thyroid eye disease (TED) (n=29), sarcoidosis (n=14) and granulomatosis with polyangiitis (GPA) (n=7). Fibrosis was scored on a 0–3 scale by two experts, ophthalmic pathologists. Gene expression was quantified using Affymetrix U133 plus 2.0 microarray. Results Within orbital fat, fibrosis was greatest among subjects with GPA (2.75±0.46) and significantly increased in tissue from subjects with GPA, NSOI or sarcoidosis (p Conclusions A pathologist9s recognition of fibrosis in orbital tissue correlates well with increased expression of transcripts that are considered essential in fibrosis. Many transcripts implicated in orbital fibrosis have been previously implicated in pulmonary fibrosis. TED differs from other causes of orbital fat inflammation because fibrosis is not a major component. Marked fibrosis is less common in the lacrimal gland compared with orbital adipose tissue.

/pdf/fibrosis-gene-expression-and-orbital-inflammatory-disease-30786sczh7.pdf

Fibrosis, gene expression and orbital inflammatory disease

Resection of a continuous layer of tissue by means of Mohs' micrographic surgery is problematic at several periorbital sites. We describe a technique in which methylene blue is used to identify instances of incomplete specimen removal and thus facilitate subsequent complete removal.

Methylene blue stain guiding layered excision in Mohs' micrographic surgery.

Intravascular large B-cell lymphoma is a rare B-cell lymphoma subtype characterized by tumor cells found exclusively within vascular lumina. We report the case of an 88-year-old woman who initially presented with pain, swelling, and loss of vision in her left eye. A left orbital mass was revealed by computed tomography, and a biopsy was performed. On histologic examination, large atypical lymphoid cells were present in blood vessel lumina of the intraorbital adipose tissue. No tumor cells were seen in the surrounding tissue. By immunohistochemistry, the tumor cells were positive for CD20, BCL-2, Bcl-6, and CD5; they were negative for CD10 and cyclin D1. Ki-67 revealed a proliferation rate of approximately 80–90%, and CD31 highlighted the vascular endothelium. These findings confirmed the diagnosis of intravascular large B-cell lymphoma. Results of bone marrow and cerebrospinal fluid examinations were negative for involvement, and there was no radiographic evidence of systemic disease. The patient received systemic treatment with etoposide, doxorubicin, vincristine, cyclophosphamide, prednisone, and rituximab in addition to intrathecal methotrexate. The patient had resolution of her intraorbital mass. While it is understood that this disease can involve any organ, only very rarely does intravascular large B-cell lymphoma present with primary ophthalmologic symptoms. Additionally, this patient’s disease initially appeared to be isolated, with no skin manifestations or other systemic involvement. To our knowledge, this is the first reported case in which this disease manifested as an isolated intraorbital mass without detectable involvement of any other organ.

https://link.springer.com/content/pdf/10.1007%2Fs12308-011-0102-z.pdf

Patrick Yeatts

Papers

Management of periocular basal cell carcinoma: Mohs' micrographic surgery versus radiotherapy

Fibrosis, gene expression and orbital inflammatory disease

Methylene blue stain guiding layered excision in Mohs' micrographic surgery.

Isolated intraorbital intravascular large B-cell lymphoma: a case report