tailieunhanh - Fundamentals of Clinical Ophthalmology - part 4

do phần thường trú hoặc đông lạnh. Nếu một sinh thiết của một khối u nghi ngờ là thực hiện trước khi xác định một thủ tục phẫu thuật, chăm sóc cần được thực hiện để có được một phần đại diện của khối u. Cạo sinh thiết không cho phép xác định của cuộc xâm lược da bởi khối u biểu mô. | PLASTIC and ORBITAL SURGERY either by permanent or frozen section. If a biopsy of a suspicious tumour is done before a definitive surgical procedure care should be taken to obtain a representative section of the tumour. Shave biopsies do not allow determination of dermal invasion by the epithelial tumour. Benign tumours such as actinic keratosis kerato-acanthoma inverted follicular keratosis and pseudo-epitheliomatous hyperplasia can be differentiated only by evaluation of dermal extension. As such the pathologist is frequently forced to give a diagnosis of squamous carcinoma because inadequate tissue has been submitted for review. It is not unusual for a tumour that has been reported as squamous cell carcinoma to have resolved by the time definitive surgical resection can be scheduled for this reason. If the lesion is small an excisional biopsy with direct closure of the defect should be performed. If the lesion is larger an incisional biopsy should be performed. The specimen should be handled with care to avoid any crush artefact. If the lesion involves the eyelid margin the biopsy should be full-thickness. Wherever possible the base of the lesion and adjacent normal tissue should be included. Laissez-faire is useful for healing of many biopsy sites. As in the management of BCC Mohs surgery is the gold standard. Exenteration is reserved for cases where orbital invasion has occurred and aggressive surgical management is appropriate for the individual patient. Sebaceous gland carcinoma Management Surgery Irradiation. It is important to routinely examine for evidence of pagetoid spread multicentric origin by performing random conjunctival sac biopsies. It is appropriate to biopsy any areas of telangiectasia papillary change or mass. 52 The management of SGC consists of surgical extirpation of the tumour. With heightened appreciation of the clinical presentation of the tumour early surgical excision significantly enhances the long-term prognosis. Numerous procedures

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