The treatment of tumors of the eyelid is both complex, and fascinating. The choice of treatment depends upon, the type of tumor (benign, malignant, specific diagnosis),, size, location (upper or lower eyelid, canthus involvement,, deeper involvement to ocular surface or orbit), the, age and systemic health of the patient, and the surgeon’s, preference (see Chapter 2).1, For appropriate management, the basic oncological principles, must be followed:, • Adequate tissue biopsy for diagnosis., • Assessment of tumor margins., • Evaluation for local and systemic spread., In Chapter 36 we discuss the clinical features of common, eyelid tumors. Herein we discuss the management,, including surgery, radiation, cryotherapy, PDT, and, chemotherapy (Mind Map 37-1). We also provide a broad, overview of reconstructive techniques following excision, and the prognosis of common eyelid malignancies.
Chapter Keyword: resection
Treatment of Iris Tumors
Iris neoplasms include nevi, melanocytomas, melanomas,, hamartomas (e.g., Lisch nodules), as well as cysts of the, iris stroma and pigment epithelium. Amelanotic tumors, are more likely vascular, epithelial, or metastatic.1,2 Most, can be distinguished by clinical examination, including, slit lamp, gonioscopic, ultrasound, optical coherence, tomography (OCT), and angiographic techniques.3, However, diagnosing small indeterminate lesions can be, difficult. They may require photographic documentation, for growth over several weeks, months, or even years as, well as for biopsy (see Chapter 5)., It is important to determine the entire anatomic extent, of the tumor, as tissue invasion and displacement can, help determine if a tumor is benign or malignant. For, example, this is particularly important for iris melanoma, extending into the ciliary body or a primary ciliary body, tumor extending into or through the iris root. For this, reason, slit-lamp imaging, gonio-photography, UBM,, and anterior segment OCT imaging as well as fluorescein, angiography (FA) help this determination. The usefulness, of CT and MRI has been described but is less helpful, in discriminating between different types of iris tumors.4, Treatments for any individual tumor depend highly on the, clinical or biopsy-proven diagnosis, size, and extent. Benign, lesions (e.g., nevi and small cysts) are typically observed, and may not require treatment. Because of their anterior, and clearly visible location, iris tumors—especially iris, melanomas—are treated when relatively small compared, to more posteriorly located uveal melanoma, yielding, more favorable prognoses. Treatment modalities typically, include surgical excision (sector iridectomy), radiation (e.g.,, charged particle, plaque brachytherapy), and enucleation.5-7