Malignant eyelid tumors

Maligne bolesti vjeđa javljaju se rjeđe u odnosu na benigne promjene, ali od velikog su značaja zbog blizine vitalnih struktura oka i lokalizacije navedenih tumora. Obzirom na patohistološki nalaz mogu se podijeliti na primarne, sekundarne i metastatske maligne tumore. Najčešći maligni epitelni tumori vjeđa su bazocelularni karcinom i planocelularni karcinom. Bazocelularni karcinom je ujedno najčešći zloćudni tumor vjeđa. Češće zahvaća donju vjeđu, učestaliji je u starijoj populaciji, iako je sve veći broj pripadnika mlađe populacije kod kojih se javlja tumor. Najvažniji rizični faktor je prolongirana izloženost ultraljubičastom zračenju. Planocelularni karcinom maligni je epitelni tumor koji se javlja rjeđe od bazocelularnog, češće u starijih hipopigmentiranih osoba koje se pretjerano izlažu ultraljubičastom zračenju. Započinje u stratificiranom dijelu epidermisa, može prodirati u dublje dijelove dermisa te metastazirati najčešće limfogenim putem. Adenokarcinomi lojnih žlijezda su izrazito maligni tumori. Uglavnom potječu od Meibomovih žlijezda te se rjeđe javljaju u odnosu na epitelne maligne tumore. Češće se javljaju u starijoj životnoj dobi, u ženskoj populaciji. Skloni su lokanom metastaziranju, češće limfogenim putem. Ostali češći maligni tumori su Merkelov tumor vjeđe te melanomi vjeđe. Klinička slika navedenih tumora ovisi o lokalizaciji i stupnju invazivnosti tumora, a u glavnini se očituje promjenom izgleda i oblika, oteknućem, zadebljanjem vjeđe, pojavom uzdignuća ili ulceracija koji ometaju funkciju vjeđe. Terapija malignih tumora vjeđa također ovisi o veličini i agresivnosti te lokalizaciji same promjene. Nastoje se koristiti metode koje istodobno pružaju radikalnost odnosno ograničavaju daljni tumorski rast i oštećenje okolnog tkiva, ali istovremeno čuvaju strukturu i funkciju vjeđe. Započinje se sa incizijskom ili ekscizijskom biopsijom kao dijagnostičkim postupkom nakon čega se tkivo šalje na patohistološku analizu kako bi se otkrio maligni potencijal. Nakon toga se odabire adekvatna terapija koja osim radikalne kirurške ekscizije može uključivati: radioterapiju, kemoterapiju, krioterapiju, imunomodulaciju i druge konzervativne metode liječenja.Malignant eyelid tumors occur less often than benign tumors, but they are of great importance due to the proximity of vital eye structures and localization of these tumors. By pathohistological features, they can be classified into primary, secondary and metastatic malignant tumors. The most common malignant eyelid epithelial tumors are basocellular carcinoma and planocellular carcinoma. Basocellular carcinoma is the most common malignant eyelid tumor. It occurs more often in the lower eyelid, and it is more common in the older population, although the incidence among the younger population is on the rise. The most important risk factor of disease is prolonged exposure to ultraviolet radiation. Planocellular carcinoma is a malignant epithelial tumor that occurs less often than basocellular carcinoma, more often in older hypopigmented people who over-expose themselves to ultraviolet radiation. It begins in the stratified part of the epidermis, can penetrate into the deeper parts of the dermis and metastasize through lymphatic spread. Sebaceous gland adenocarcinomas are extremely malignant tumors. They are mainly derived from Meibomiam glands and occur less frequently than epithelial malignant tumors. Sebaceous gland adenocarcinomas occur more often in older age of female population. They are prone to local aggressive metastasizing, more often by lymphatic spread. Other more common malignant tumors are Merkel's eyed tumor and melanoma. The clinical presentation of these tumors depends on the localization and degree of invasiveness of the tumor. It is manifested by a change in appearance and shape of eyelids, swelling, eyelid thickening, appearance of elevations or ulcerations that interfere with eyelid function. Eyelid malignant tumor therapy also depends on the size and aggressiveness and localization of the change itself. The aim is to use methods that simultaneously provide radical tumor removal and inhibit further tumor growth and damage to surrounding tissue, but at the same time preserve eyelid function and structure. It begins with an incision or excision biopsy as a diagnostic procedure after which the tissue is sent to pathohistological analysis in order to search for malignant potential of the tissue. After that, therapy is selected such as radiotherapy, chemotherapy cryotherapy, immunomodulatory therapy and other conservative methods of treatment