|Year : 1988 | Volume
| Issue : 4 | Page : 165-167
Cryo surgery for lid tumors
Amita Govind, PA Lamba
Rotary Eye Hospital, Maranda, Dist. Kangra, Himachal Pradesh - 176 102, India
Rotary Eye Hospital, Maranda, Dist. Kangra, Himachal Pradesh - 176 102
Source of Support: None, Conflict of Interest: None
Five cases of malignant lid tumors are presented. These include one case of basal cell carcinoma, two cases of meibomian cell carcinoma and two cases of squamous cell carcinoma. The cases in which the tumor was large in size (more than 10 mm diameter) were subjected to cryotherapy to be followed by surgery at a later date (2 cases). Cryotherapy alone was considered as an ideal therapy for tumors with a wide base situated at the lid margin. In cases with tumor size less than 10 mm or with a narrow base surgical excision with surgical repair of the defect produced good results.
Cryotherapy should be considered favourably, as a modality for management of eyelid malignancies, either prior to surgery for large size tumors (more than 10 mm- diameter) or as a primary procedure for tumors with a wide base at the lid margin. For tumors less than 10 mm in size or tumors with narrow pedicle, surgical excision & repair is considered ideal.
Keywords: Cryotherapy, lid malignancy, sur-gical excision
|How to cite this article:|
Govind A, Lamba P A. Cryo surgery for lid tumors. Indian J Ophthalmol 1988;36:165-7
| Introduction|| |
Cryotherapy for lid malignancy is a recently tried procedure ,, Fraunfelder et. a1  reported a 5 year cure rate comparable to other modes of therapy for lid malignancies. Best results are achieved when the tumor is 10 mm or less in diameter; Cryotherapy has been recommended as a primary procedure for lid malignancies, especially for tumors 10 mm or less in diameter.
We report here our observations and results with cryotherapy and surgical excision in five cases of lid malignancies. The histopathological changes following the effect of cryotherapy in one of the cases is also documented.
| Report of Cases|| |
Case 1: A 45 year old female presented with a nodulo-ulcerative lesion of the left lower lid [Figure - 1]. She had already had a surgical excision and radiotherapy earlier. The skin around the lesion showed areas of hyperpigmentation. It was stretched and fibrosed due to the effects of radiation. Histopathology revealed a basal cell carcinoma of adenocystic variety [Figure - 2]. Cryotherapy was done. The technique described by Kamoao et. al [l] was followed. The procedure was repeated 3 times. There was a marked improvement in the patient's condition [Figure - 3]. Histopathology of the tumor area after several cryotheraphy applications is shown [Figure - 4]. Repair of the lower lid defect was carried out by skin grafting 1 year later [Figure - 5].
Case 2: A 75 year old female presented with a large swelling of the right lower lid [Figure - 6]. Histopathology revealed meibomian cell carcinoma. Cryoapplication was done in 2 sittings at intervals of 2 weeks. The tumor markedly decreased in size and was less friable. The lower lid did not hang down due to the weight of the tumor [Figure - 7]. A surgical excision was planned, but the patient at this stage refused surgery.
Case 3: A 50 year old lady presented with a growth with a wide base involving the margin of upper lid [Figure - 8]. Histopathologically it was a meibomian cell carcinoma [Figure - 9]. Cryotherapy was done in two sittings and the growth disappeared completely. [Figure - 10] shows the clinical picture after cryotherapy with depigmentation of skin at the site of growth.
Case 4: A 75 year old lady presented with a swelling of the left upper lid. It was small in size with a narrow base [Figure - 11]. A simple surgical excision and repair of the defect was performed [Figure - 12]. Histopathology revealed a squamous cells carcinoma.
| Discussion|| |
Cryotherapy of basal cell carcinoma (nodular and infiltrative types) measuring 10 mm or less in diameter had a cure rate of 97% and 94% respectively on 5 year follow up. Cure rate for larger carcinomas (more than 10 mm diameter) was 82 & 85%  respectively.
Beard  considers cryosurgery a better choice than radiotherapy because it is a simple procedure, more economical and easy to carry out. Unlike radiotherapy it does not damage the surrounding normal structures. It can be repeated in case of recurrence and-secondary surgery can be done without previous freezing jeopardizing the result.
Few authors have reported the results of cryotherapy for lid malignancies ,,. It was observed by them that on a 5 year follow up best cure rates were achieved when tumor size was small (10 mm or less). They therefore recommend it as a primary procedure for tumors of less than 10 mm size.
We observed that for tumors of small size (less than 10 mm diameter) and with a narrow base surgical excision and repair of defects as a primary procedure produced good results. The procedure was simple and there was no disfigurement of the lid or any loss of its function. In case of large tumors with considerable involvement of the lid, surgical excision and reconstruction as a primary procedure is difficult and repair of the defect, may not produce good functional results. Case No.1 had received radiation previously which had caused a lot of fibrosis and tightening of the skin Of the adjacent area. Cryotherapy was found useful and simple, to reduce the size of lesion. It was easily carried out and produced good results. The patient has been followed up for 3 years now. Histopathology from the tumor area after several cryo applications did not reveal any change from the previous lesions. Case No.2 had a large tumor which reduced in size considerably following two applications of cryo at an interval of two weeks. A surgical excision with reconstruction was considered difficult as a primary procedure due to the size and vascularity of tumor. A surgical excision and repair of the defect was planned after cryotherapy but the patient refused surgery at the stage. The tumor in case No.3 was situated at the lid margin with a wide base involving the lateral 1/3rd of the lid margin. A surgical excision as a primary procedure would result in considerable loss of lid margin. Single application of cryo was an effective mode of therapy.
Cryosurgery as a mode of treatment for lid tumors can be advocated for tumors of large size to reduce their vascularity and size so that surgical excision and repair can be carried out with better surgical and functional results. It is also useful as a primary mode of therapy for small tumors with a wide base or those situated at the lid margin, as surgical excision would result in the loss of a considerable area of lid or lid margin making repair difficult. For small tumors (less than 10 mm in size) with narrow base, surgical repair itself is a simple procedure. Good surgical approximation of the defect produced is possible. It requires only a single sitting under local anaesthesia and takes a short time.
| References|| |
Kamo T, Takashashi T & Mondeen M: Cryosurgery for basal cell epithelioma; Jpn. J. Ophthal, 25:449-456, 1981.
Fraunfelder Fr; Zacarian SA; Wingfield DL & Limmer BL: Results of cryotherapy for eyelid malignancies. Am J. Ophthalmol, 97:184-188, 1984.
Fraunfelder FT; Zacarian SA; Limmer & Wingfield DL: Cryo surgery for malignacies of eye lid; Ophthalmology, 87;467-465, 1980.
Beard C; Management of malignacies of eye lid, Am. Ophthalmol, 92:1-6, 1981.
[Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4], [Figure - 5], [Figure - 6], [Figure - 7], [Figure - 8], [Figure - 9], [Figure - 10], [Figure - 11], [Figure - 12]