Received: 11.09.2022; Accepted: 11.10.2022; Published on-line: 27.10.2022
Diagnostic assessment by fluorescein visualization of skin cancer lesion margins and surgical treatment of malignant skin tumors of the external nose
A. F. Yevcheva
Odesa National Medical University
TO CITE THIS ARTICLE: Yevcheva AF. Diagnostic assessment by fluorescein visualization of skin cancer lesion margins and surgical treatment of malignant skin tumors of the external nose. J.ophthalmol.(Ukraine).2022;5: 42-46. http://doi.org/10.31288/oftalmolzh202254246
Purpose: To assess the diagnostic information value of chlorin e6 fluorescence visualization of cancer lesion margins in the radical surgical removal of malignant lesions of the external nose.
Material and Methods: Thirty patients were examined and underwent surgery for malignant cancer lesions of the external nose at the department for ear, nose and throat cancer during 2017 to 2020. Half of these patients (group 2) received and the rest (group 1) did not receive a preoperative injection of Klein solution and fluorescence visualization of cancer lesion margins.
Results: Cancer lesion margins were visualized by fluorescence with chlorin e6 via deep green staining of tumor tissue. The tumor focus appeared violet, and the tumor periphery, crimson when chlorine-e6 fluorescence was excited with 630-633 nm light from a HeNe laser. Because there was no change in tumor lesion margins when compared with visualization without exposing the lesion to laser radiation, exposing the lesion to laser radiation is not mandatory. At three years after surgery, the non-recurrence rate was for 100% for the group of patients who underwent surgery with preoperative injection of Klein solution and fluorescence visualization of cancer lesion margins, and 73.4% for the group of patients who underwent surgery without chlorin e6 fluorescein visualization. Two years after primary surgery, 4 (26.6%) of group 1 patients were diagnosed with recurrent superficial cancer of the skin at the cartilage-bone interface.
Conclusion: First, the recurrence rate was 26.6% (4 of 15 patients) for the group of patients who underwent surgery without chlorin e6 fluorescein visualization, which was significantly higher than for the group of patients who underwent surgery with chlorin e6 fluorescein visualization (0 of 15 patients, z = 2.091; р = 0.037).
Second, the use of chlorin e6 fluorescein visualization of the margins of a skin lesion of the external nose in patients with malignant tumors of the external nose with tumor spread to the tissues of the medial angle of the eye and eyelid enabled a radical approach to surgical treatment to be employed in 100% of cases.
Keywords: malignant tumors, external nose, chlorin e6, fluorescein visualization
1.Anishchenko IS, Vazhenin AV. [Squamous skin cancer: clinical features, diagnostic assessment and treatment], Cheliabinsk: Ural Publishing House; 2000. Russian.
2.Buiko AS, Safronenkova IA, Piterova OV. [T3 and T4 tumors of lid-skin epithelium: whether to use combined treatment or excision alone]. Oftalmol Zh. 2002; 1: 30-34. Russian.
3.Buiko AS, Elagina VA, Safronenkova IA. [Combined treatment of T3 and T4 malignant tumors of lid-skin epithelium]. In: [Proceedings of the international conference on Tumors and Tumor-like Conditions of the Eye]. October 20-22. 1998, Moscow. Russian.
4.Kolesnik OO, editor. Cancer in Ukraine 2015–2016: Bulletin of the National Cancer Register of Ukraine. Kyiv: National Cancer Institute; 2017.
5.Lukach EV, Chepurna OM, Pashkovsky VM. [Treatment of basal cell carcinoma of the external nose by photodynamic therapy]. Rynologiia. 2017 (1): 65-7. Ukrainian.
6.Kochneva EV. [Results of phase II trial of treatment with the photosensitizer radakhlorin for basal cell skin cancer in Cheliabinsk Municipal Hospital No.1]. Rossiiskii bioterapevticheskii zhurnal. 2005; 4 (4): 92–95. Russian.
7.Lamotkin IA. [Atlas of Clinical Dermatooncology]. Moscow: BINOM; 2011. Russian.
8.Chaqas FSC, Silva B de S. Mohs micrographic surgery: a study of 83 cases. An Bras Dermatol. 2012 Mar-Apr;87(2):228-34.
9.Henderson BW, Dougherty TJ. How does photodynamic therapy work? Photochem Photobiol. 1992 Jan; 55(1):145–57.
10.Ievcheva AF. [Current diagnostic assessment of malignant tumors of the external nose and ear]. Otorinolaringologiia. 2019; (2-3); 47–52. Ukrainian.
11.Kapinus VN, Kaplan MA, Spichenkova IS, et al. [Photodynamic therapy with chlorine e6 for squamous cell skin cancer]. Lazernaia meditsina. 2012;16:2:31-34. Russian.
12.Kuhne K, Konz V. [Current recommendations for therapy for basal cell and squamous cell skin cancer]. Dermatolog. 2012; 3:179-86. Russian.
13.Vit VV. [Tumors of the eye]. Vol. 1. Odesa: Astroprint; 2009. Russian.
14.Paches AI. [Tumors of the head and neck]. Moscow: Meditsina;2000. Russian.
15.[Uniform clinical protocol of primary, secondary (specialized) and tertiary (highly specialized) care for basal cell skin cancer. Order of the Ministry of Health of Ukraine No. 266 dated 28.03.2016]. Ukrainian. http://mtd. dec. gov. ua/images/dodatki/2016 – 246- BRshkiry 2016 246 YKPMD- BKR. pdf.
16.Gantsev ShKh, Iusupov AS. Squamous cell skin cancer. Prakticheskaia onkologiia. 2012; 13(2): 87-9. Russian.
17.Veness M, Richards S. Role of modern radiotherapy in treating skin cancer. Australas J Dermatol. 2003 Aug; 44(3): 159-166.
Corresponding Author: Angelina Yevcheva, email: firstname.lastname@example.org
Author Contribution: The author acknowledges sole responsibility for the following: conception and design of the study, acquisition of data, analysis and interpretation of results, and drafting of the manuscript.
Funding Sources: There are no external sources of funding.
Conflict of Interest: The author declares that she has no conflicts of interest that could influence her opinion on the subject matter or materials described and discussed in this manuscript.