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MultiPurpose                                         Dr. Saurin Gandhi

Cancer


Skin Tumors

The face and eyelids are very common locations for skin cancer. Many times skin cancers may appear as benign growths. Other times they can develop cancerous characteristics over a relatively short time. Potential warning signs are new growths with elevated, irregular borders, coloration, indentation, or ulceration. If skin cancer forms along the edge of the eyelid it often causes the eyelashes to fall out. The Eye plasty center uses state of the art technology. The area of concern is first biopsied to determine if it is in fact a cancer. If the biopsy is not cancerous, no further treatment is required. If the biopsy is cancerous, most cancers are then removed using various techniques preserving the most normal tissue around the eyelids and face. The major added value of The Eye plasty center after the cancer is removed. It is paramount that our patients not only obtain cure of the cancer but also achieve the best possible post reconstruction function and facial appearance. Dr. Saurin has extensive experience in performing both reconstructive and aesthetic surgery and each comes into play in reconstructing the defect left by tumor removal in a way that maximizes facial appearances.

  • What is the most common type of skin cancer?

    Basal cell carcinoma is the most common type of skin cancer followed by squamous cell carcinoma. Melanoma is less frequent but it is more likely to metastasize, so diagnosing melanoma early is important. In Indian skin, Sebaceous gland cancer is also relatively more common.

  • What causes skin cancer?

    Risk factors we are born with include: fair complexion, light colored eyes, blond or red hair, tendency to burn instead of tan, family history of skin cancer, and a weakened immune system. People who have had a prior skin cancer are much more likely to form another. The number one modifiable risk factor for skin cancer is sun exposure.

  • How does sun exposure contribute to skin cancer?

    Ultraviolet light damages the skin cells and causes them to become cancerous.

  • Is all ultraviolet light bad?

    Yes. Ultraviolet light can be divided into the A rays and the B rays. The B rays are more responsible for causing skin cancer but the A rays can also act as tumor promoters. The A rays actually penetrate deeper into the skin are more responsible for the loss of skin elasticity and premature aging of the skin seen in those with chronic sun exposure. It is important to choose sunscreen that blocks out both A and B rays.

  • Is it true that one really bad sunburn can cause skin cancers later in life?

    Yes.

  • When do most people get sun damage to the skin?

    Most sun damage occurs prior to the age of 18. It is very important that children be protected from the sun and that sunburns not be an acceptable in children.

  • Is skin cancer becoming more common?

    Yes. More than one million skin cancers are diagnosed each year. All types of skin cancer are becoming more frequent in part to depletion of the ozone layer of the atmosphere.

  • How is skin cancer diagnosed?

    The important first step is that the patient or the doctor suspect that a lesion might be a skin cancer. The lesion is then biopsied and sent to be examined with a microscope. If the lesion is a skin cancer it will require further treatment to remove it completely.

  • What changes on my skin should I suspect are skin cancer?

    Skin cancer does not hurt. Sometimes it will be elevated about the surface of the skin but often is flat. A scab that falls off to reform in the same place is very often a skin cancer. Any skin abrasion that does not heal is very suspicious for a skin cancer. Pigmented lesions or moles that are Asymmetrical, have an irregular Border, have different shades of brown black or tan Color, have a Diameter of > 6mm, or Evolving (changing) over time are suspect of being melanoma.

  • What can I do to prevent skin cancer?

    Avoid sunburns or excess sun exposure, avoid tanning booths, and protect your children from the sun! Use broad spectrum SPF 45 or greater sunscreen and apply it liberally and frequently. The stated SPF (Sun Protection Factor) is applicable at the time of application, but decreases exponentially afterwards. Hence, care should be taken to re-apply the sunscreen after two hours, on continued sun exposure. Wear sunglasses and a broad brimmed hat when in the sun.

  • I have a history of sun exposure; what can I do to prevent this from being a problem.

    As with most things you cannot take back what you did when you were young. However, you can assist by bringing any suspicious lesion to the attention of your primary care doctor, a dermatologist, or one of the doctors at the Eye Plasty Center. Often a skin cancer is noted by the way it changes with time. It is very useful to bring to the attention of a doctor that a skin change is getting bigger, sometimes bleeds, or sometimes forms a scab. Skin cancers are much easier to treat and less likely to leave a scar when they are small when diagnosed.

  • What role do the doctors at the Eye Plasty Center play in diagnosing and treating skin cancers?

    Your doctors can biopsy any suspicious lesion. I expertise in reconstructing the defects left after skin cancer has been removed from the eyelids, face, or trunk. Our goal is to cure you of the cancer and to restore normal appearances.

    These common forms of facial cancers and hundreds of other less common forms can be corrected by Dr. Saurin with an evaluation and subsequent surgery. If you are looking for an expert in diagnosing, evaluating and treating your facial cancer, look no further than The Eye Plasty Center. Remember, cancer can kill! Evaluating a facial lesion suspiciously right at the beginning can save your life.

Basal Cell Carcinoma

The most common type of eyelid cancer is basal cell carcinoma. Most basal cell carcinomas can be removed with surgery. If left untreated, these tumors can grow around the eye and into the orbit, sinuses and brain. Basal cell carcinomas are more commonly found on the lower eyelids and almost never spread to other parts of the body (metastasize).

Symptoms

Patients with basal cell carcinomas most commonly notice a reddish nodule slowly forming on their eyelid. The tumor is most commonly found on the lower eyelid, followed by the medial canthus (toward the nose) and can occur on the upper eyelid. Eyelash loss (around the tumor) suggests that a tumor is malignant.

Less commonly, basal cell cancers can be pigmented or present without any nodule at all. When the tumor does not make a nodule and grows within the eyelid, it can induce pulling of the eyelid (away from the eye). These cases (morpheaform variant) are much more difficult to treat because its edges are harder to define.

Diagnosis

Though small tumors can be photographed and followed for evidence of growth (prior to biopsy); once your eye cancer specialist suspects basal cell carcinoma, most eye cancer specialists will suggest a simple wedge eyelid biopsy. This specimen is sent to the pathologist to confirm the diagnosis prior to complete removal of the tumor.

Wedge biopsies can be performed in the doctor's office, or in the operating room prior to definitive treatment.

Treatments

Once the diagnosis is confirmed by the pathologist, complete excision will be recommended. Both techniques require that the surgeon continue to remove the tumor until the margins (edges) are negative (free of tumor). Unlike most areas of skin, the eyelids are a complex functional apparatus that requires special reconstruction techniques.

Most basal cell carcinomas can be cured when they are small. Unfortunately, some patients choose to ignore or deny the existence of these tumors. Those patients allow their tumor to invade behind the eye and become difficult or impossible to remove. In these cases radiation and chemotherapy may be offered to control or destroy the tumor.

Squamous Carcinoma

Squamous carcinomas of the face and the eyelid can locally invade the orbit and sinuses, but rarely metastasizes. It is the second most common malignant eyelid tumor, but is 10 times less common than basal cell carcinoma. It is the most common conjunctival cancer and may spill over onto the eyelid.

Symptoms

Patients with squamous eyelid tumors can have symptoms that range from the appearance of a hypervascular flat reddish or flaky lesion on the eyelid skin to a thickened well-demarcated reddish, flat tumor surrounded by inflammation (with or without scaling from its surface).

Diagnosis

Squamous carcinoma of the eyelid should be photographed at baseline. These lesions can remain unchanged (for years), then invade into the dermis and grow. A simple wedge biopsy can be performed in the office setting and sent for pathologic evaluation. Once the diagnosis of squamous carcinoma is biopsy proven, definitive treatment is needed.

Treatments

Like basal cell carcinomas, squamous cell cancers of the eyelid rarely metastasize. They can grow around the eye into the orbit, sinuses and brain. Therefore, early intervention with complete excision is warranted. Dr. Saurin will perform a planned excision to remove the entire tumor along with a small safety zone of normal appearing tissue from the edges of surgical wound (margins). When the orbit and sinuses are not involved, local excision is usually curative.

Extension into the orbit and sinuses typically requires more extensive surgery (exenteration, sinusectomy) with subsequent radiation therapy.

Sebaceous Carcinoma of the Eyelid

Sebaceous carcinoma arises from the glands within the eyelids, caruncle or eyebrow. They are more commonly found on the upper eyelid and in middle-aged patients.

Sebaceous cell carcinoma is suspected due to evidence of eyelash loss and the formation of a yellow-nodule. This tumor can also present as a persistent (months) non-responsive redness of the eye or conjunctivitis. In these cases, a high index of suspicion for sebaceous cell carcinoma will lead to biopsy and the diagnosis. Once sebaceous carcinoma is suspected a biopsy is warranted. Before surgical biopsy, Dr. Saurin informs the pathologist of this possible diagnosis so the specimen can be processed appropriately.

Symptoms

Sebaceous carcinomas are one of the rarest eye cancers and can look like a chalazion (stye – a swelling of the glands in the lid). Any conjunctivitis or chalazion that is not getting better after 3 months of observation, should be biopsied.

Diagnosis

Sebaceous carcinoma of the eyelid typically presents as a yellow-nodule in the upper lid. The tumor can cause eyelash loss and is not painful. This tumor can also present as a hypervascular conjunctival tumor and tends to spread along the conjunctival surface. The gold standard for diagnosis of sebaceous carcinoma is histopathologic evaluation on fresh tissue.

Treatments

Once the diagnosis is made, a metastatic survey (looking for other sites of cancer) is warranted. Sebaceous carcinoma can spread to regional lymph nodes (pre-auricular and cervical) as well as to lungs, brain, liver and bone. Published series have reported that the occurrence of metastatic disease was dependent on the size and location of the primary tumor and occurred in up to 27% of patients. Local tumor invasion of the lymph nodes, orbit or metastatic sites were associated with a poor prognosis for survival.

Treatment requires a COMPLETE resection. We use frozen section control to provide negative margins. Larger surgeries, cryodestruction and radiation may be required if resection is not possible. Exenteration (complete removal of the orbital contents is sometimes required for extensive or recurrent disease).

Malignant Melanoma of the Eyelid

Melanoma of the eyelid is a relatively rare tumor making up less than 1% of eyelid cancers. It typically appears as a pigmented thickening (tumor) of the eyelid or extension of pigment from the conjunctiva.

Symptoms

Malignant melanoma of the eyelid is distinguished from an eyelid nevus in that it can be variably pigmented, change color, bleed and/or grow. All pigmented tumors of the eyelid should be evaluated by an eye care specialist with experience with melanoma.

Diagnosis

All pigmented eyelid tumors should be photographed for comparison with future examinations. Patients should keep a copy of their baseline photographs.

Malignant melanoma of the eyelid is distinguished from an eyelid nevus in that it can be variably pigmented, change color, bleed and/or grow. Suspicious eyelid tumors should be evaluated by biopsy. A simple wedge biopsy can be sent for pathologic evaluation to aid in the diagnosis.

Treatments

If the pathologic diagnosis is malignant melanoma of the eyelid, a medical work-up is ordered to rule out metastatic spread to other parts of the body. If there is no metastatic disease, the tumor can be surgically removed (including large margins of normal appearing tissue). At the time of surgery, some doctors will also remove regional lymph nodes near the tumor (in order to determine if the tumor has locally spread).

Facial plastic surgery techniques are usually required to repair the defect caused by tumor removal.

Orbital Tumors

The orbit is the bony box in which the eye lies. Tumors and inflammations can occur behind the eye. They often push the eye forward causing a bulging of the eye called proptosis.

Tumors and inflammations can occur behind the eye. They often push the eye forward causing a bulging of the eye called proptosis. The most common causes of proptosis are thyroid eye disease and lymphoid tumors (lymphoma and atypical lymphoid hyperplasia).

Other tumors include vascular tumors (e.g. hemangiomas, lymphangioma), lacrimal gland tumors (e.g. dacryoadenitis, benign mixed tumor, sarcoidosis and adenoid cystic carcinoma), and growths that extend from the sinuses into the orbit (e.g. squamous carcinoma, mucocele). Metastatic cancer can also form an orbital tumor. Lastly, an orbit tumor can also be caused by inflammation (e.g. pseudotumor, sarcoidosis) or infection (abscess).

Symptoms

Most patients with orbital tumors notice a bulging of the eyeball. Infections, inflammations and certain orbital cancers can also cause pain. Less commonly, orbital tumors may be an incidental finding on CT or MRI of the head, sinuses and orbit.

Diagnosis

Though CT, MRI’s and ultrasound can help in determining the probable diagnosis, most orbital tumors are diagnosed by a surgical biopsy called an orbitotomy (anterior or lateral). A specimen is sent to an ophthalmic pathologist who helps determine the exact diagnosis.

Treatments

When possible, orbital tumors are totally removed by Dr. Saurin using the latest techniques in orbital surgery. Surgery is delicate as the goal of vision is to prevent damage to the optic nerve which is responsible for sight. The orbital structures are full of nerves and vessels and prevention of damage to these requires adequate expertise and training. If the tumor cannot be completely removed or if removal will cause too much damage to other important structures around the eye, a piece of tumor may be removed by Dr. Saurin and sent for evaluation by an eye-pathologist. Occasionally an orbital tumor is too big or involves the sinuses and requires more extensive surgery with bone-flaps.

If tumors cannot be removed during surgery, most orbital tumors can be treated with external beam radiation therapy. Certain rare orbital tumors require removal of the eye and orbital contents. In certain cases orbital radiotherapy may be used to treat any residual tumor (in an effort to spare vision and the eye).

Conjunctival Tumors

Malignant Conjunctival Tumors

Malignant cancers can grow on the surface of the eye. They usually start from the membrane that covers most of the eye called the conjunctiva. The most common conjunctival cancers are squamous carcinoma, malignant melanoma - PAM complex, and lymphoma.

Squamous carcinoma of the conjunctiva can form a nodule or diffusely spread out over the surface of the eye. Squamous conjunctival cancers rarely metastasize to other parts of the body, but they can invade around and into the eye, as well as behind the eye into the orbit and sinuses.

Malignant melanoma can start as a conjunctival nevus, arise as newly formed pigmentation called primary acquired melanosis (PAM), or just appear as a new tumor within the conjunctiva. A simple biopsy can determine whether a pigmented conjunctival tumor is a benign nevus, primary acquired melanosis, or conjunctival melanoma.

Both squamous carcinomas and malignant conjunctival melanomas should be removed or destroyed.

Lymphoma can also occur in the conjunctiva. These tumors look like red or salmon-colored patches on the eye and can be the first sign of systemic lymphoma. Dr. Saurin usually biopsies lymphoid tumors so that a pathologist can perform special immunologic and genetic studies on the tumor cells. These techniques are used to determine if the tumor is benign or malignant. Patients with lymphoid conjunctival tumors should have a complete medical check up and be examined by a hematologist-oncologist.

Symptoms

Most conjunctival tumors do not cause symptoms. Patients typically seek medical attention because they notice a discoloration on the eye or extension of the tumor onto the cornea. Conjunctival tumors can also be found by an eye care specialist during a routine eye examination.

Diagnosis

Most small benign-appearing conjunctival tumors can be photographed and followed for evidence of growth prior to biopsy or treatment. If they are raised, hypervascular or extend onto the cornea a biopsy is reasonable.

Evaluation of the biopsy specimen should be performed by an experienced ophthalmic pathologist. If there isn't an ophthalmic pathologist in your area, you can request that the histopathology slides be sent for second opinion.

Treatments

Small tumors can be completely removed, and if they are found to be either squamous carcinoma or malignant melanoma, additional cryotherapy (freezing) may be necessary.

Dr. Saurin uses specialized "Finger-tip" cryotherapy probes to uniformly freeze large surfaces of the eye with minimal intraocular penetration.

Conjunctival melanoma and squamous carcinoma can be difficult to treat if they occur in multiple spots on the eye. In these cases, even surgical removal with freezing therapy may not control the tumor.

Several groups of oncologists are currently investigating the use of chemotherapy eye-drops for patients with conjunctival melanoma. Chemotherapy eye-drops treat the entire surface of the eye, are less dependent upon defining the tumors edges, and may decrease the chance of scarring after surgery.

Systemic lymphoma can usually be treated with standard chemotherapy that is also likely to cure malignant ocular lymphomas. If the eye is the only site of malignant lymphoma, external beam radiation therapy is commonly employed.

Retinal Tumors

Retinoblastoma

Retinoblastoma is the most common intraocular cancer of childhood and affects approximately 5000 - 8000 children in the world each year. More than 90% of children can be cured of retinoblastoma by early detection and treatment of the affected eye. Unfortunately, some children can have both eyes affected. Whenever possible, Dr. Saurin tries to save a child’s eye and preserve their vision.

Symptoms

Leukocoria (white pupil) and misaligned eyes (strabismus) are the most common signs of retinoblastoma. In other cases, the child may have developed neovascular glaucoma and may be in pain. Longstanding glaucoma can cause enlargement of the eye (buphthalmos). Children with neovascular glaucoma and enlargement of the eye are at greater risk for extraocular spread of their retinoblastoma.

A family history of retinoblastoma can be very important. Retinoblastoma was the first cancer to be directly associated with a genetic abnormality (Deletions or mutation of the q14 band of chromosome 13). Retinoblastoma can occur sporadically (without a family history) or it can be inherited (with a family history).

If a genetic mutation is found there is a 45-50% chance that the parents will have another child with retinoblastoma. If there is no family history and no mutation is found, the risk of having a second child with retinoblastoma is 2-5%. The average age of children first diagnosed with retinoblastoma is 18 months.

Diagnosis

More than 75% of children with retinoblastoma are first noted to have a “white-pupil” (which the doctors call leukocoria), or poorly aligned eyes (which the doctors call strabismus), or a red and painful eye (usually due to glaucoma). Other eye diseases which can cause these symptoms include congenital cataract, Toxocara canis, Coat’s disease, and persistent hypertrophic primary vitreous (PHPV). These diseases may look like retinoblastoma, but by performing an examination under anesthesia, specialized blood tests, digital photography, radiographic scans, and ultrasound evaluations Dr. Saurino can diagnose intraocular retinoblastoma in over 95% of cases. In order to be 100% correct all the time, Dr. Saurin would have to perform a biopsy. Biopsies of intraocular retinoblastoma are avoided in order to prevent cancer cells from spreading outside of the eye.

The presence of orbital extension, uveal involvement, and optic nerve invasion are known risk factors for the development of metastatic retinoblastoma.

Treatments

Retinoblastoma treatment typically requires the cooperation of an ophthalmic oncologist, pediatric oncologist, and radiation therapist. Over the last 30 years, treatment has evolved from simple enucleation (removal of the eye), to eye-sparing radiotherapy, and more recently to chemotherapy-based multi-modality therapy (for selected cases).

Though retinoblastoma has been cured by external beam irradiation, investigators have suggested that radiation may cause an increase in the risk of developing second cancers later in life.

Protocols are currently being evaluated to use chemotherapy to shrink the retinoblastoma in order to treat them with laser therapy, freezing therapy (cryotherapy), and local “plaque” radiation. Where applicable, these techniques are thought to be safer than external beam irradiation for retinoblastoma. There is little long-term data on the safety of this type of multi-modality chemotherapy.

Treatment of retinoblastoma often requires a team of doctors made up of ophthalmic, radiation and pediatric oncologists. These doctors should evaluate your child, discuss all the different forms of treatment, and make them available. Dr. Saurin has performed path-breaking work on the treatment of retinoblastoma as well as better cosmesis for children in whom the eye has had to be removed. While saving the eye is the attempt in every child, it is also important to remember that in a child, cosmesis and looking ‘normal’ in the vicinity of peers can be an important part of sound development.

Choroidal Melanoma

Malignant "choroidal" melanoma can grow within the eye. They arise from the blood-vessel layer "choroid" beneath the retina. Choroidal melanoma can spread to other parts of the body.

Dr. Saurin determines if you have a choroidal melanoma by performing a complete eye examination. This includes asking questions about your medical history, examining both of your eyes, looking into the eye at the tumor, doing an ultrasound examination, and specialized photography (to examine the circulation within the choroidal melanoma).

Dr. Saurin will also request that you have a complete general medical check up and specific tests depending upon what they see inside your eye. Eye cancer specialists can correctly diagnose an intraocular choroidal melanoma in over 96% of cases (without a biopsy). Though occasionally necessary, biopsies are usually avoided because they require opening the eye which risks letting choroidal melanoma cells out.

Symptoms

Most choroidal melanoma patients have no symptoms and the melanoma is found on routine eye examination. If patients have symptoms, they are usually: seeing "flashes of light," "distortion" or loss of vision, and floating objects (floaters) in the vision.

It is important to note that most patients with choroidal melanoma have no symptoms at all. Their tumors are found when they visit their eye doctor for a "routine" eye examination. So everyone should have periodic eye examinations (including dilated ophthalmoscopy).

Diagnosis

Choroidal melanoma can be seen by ophthalmoscopy (when your eye doctor looks through a lens into your dilated pupil).

Choroidal melanoma has typical "diagnostic" characteristics that include but are not limited to: pigmentation, thickness, low or moderate internal ultrasound reflectivity, orange pigment on its surface, and leakage of fluid or retinal detachment (on or around the choroidal melanoma).

If the diagnosis of choroidal melanoma is made by your eye care professional, it is reasonable to have it confirmed by Dr. Saurin.

Treatments

Small Choroidal Melanoma:

Patients with a small choroidal melanoma can be treated after their first visit, but since growth helps to prove that the tumor is a cancer, your doctor may suggest "observation" or watching for a small amount of choroidal melanoma growth prior to treatment. Dr. Saurin would discuss the relative risks and potential benefits of both "observation for growth" as compared to "immediate treatment" for choroidal melanoma.

Medium-sized Choroidal Melanoma:

Around the world, most patients with a medium-sized choroidal melanoma are treated with either radiation therapy or removal of the eye. Though there are several forms of eye and vision sparing radiation therapy, ophthalmic plaque radiation therapy is the most commonly and widely used.

Since the results of the Collaborative Ocular Melanoma Study (COMS) suggest that plaque radiation therapy and enucleation of the eye are equally effective for the prevention of metastatic choroidal melanoma, few patients with medium-sized choroidal melanoma are treated by removal of the eye.

In that both enucleation and plaque radiation therapy for choroidal melanoma are likely to harm your vision (in that eye). You should discuss the risks and benefits of these and other treatment options in consultation with Dr. Saurin.

Large-sized Choroidal Melanoma:

A patient with a very large choroidal melanoma may be treated by removal of the eye (enucleation). This is because the amount of radiation required to kill a choroidal melanoma that fills most of the eye may be too much for the eye to tolerate.

However, most patients with large-sized choroidal melanoma can be also be treated with eye-sparing radiation therapy. After radiation for large choroidal melanoma, these eyes are at greater risk to have poor vision, to become uncomfortable and may have to be secondarily removed.

Additional Info

It is important to note that as compared to like-sized malignant melanoma of the skin, patients are much more likely to survive a choroidal melanoma. This is because it is much more difficult for a choroidal melanoma to spread from (get out of) the eye to other parts of the body. However, large (choroidal melanoma) tumor size decreases the chance that vision-sparing treatments will be successful. In general, the larger the choroidal melanoma the worse the prognosis for both vision and life.

Choroidal Metastasis

Malignant tumors from other parts of the body can spread in and around the eye. These tumors may never be discovered unless they affect vision, are visible to the patient, or push the eye forward. The most common location for ocular metastasis, in the vascular layer called the choroid (choroidal metastasis) within the eye.

Cancer metastasis that appear in and around the eye are usually from a breast cancer (in women) and lung cancer (in men). Other less common sites of origin include the prostate, the kidney, the thyroid, and gastrointestinal tract. Blood cell cancer (lymphoma and leukemia) can also metastasize to the eye and orbit. Once a patient is diagnosed with choroidal metastasis, we try to find where it came from. In 18% of patients, we do not find the source of choroidal metastasis. In these , we may have to biopsy the ocular tumor and look at its cell-type.

Symptoms

Most patients with choroidal metastasis have no symptoms. If the metastasis is on the eye or eyelids, it may be visible. If located behind the eye (in the orbit), the metastasis can push the eyeball out or to the side. If within the eye (the most common), choroidal metastasis patients can see flashing lights, floating spots or distortion of their vision. Patients with a history of cancer are at greatest risk and should have periodic eye examinations.

Diagnosis

Most patients with metastasis have either a known primary cancer and/or metastatic tumors in other parts of their body. A careful medical history can uncover the signs or symptoms of these other cancers. If an eye cancer specialist suspects ocular metastasis, both eyes and orbits should be examined because ocular metastases can be both bilateral and/or multifocal.

Choroidal metastasis is usually non-pigmented (except metastatic melanomas), and has typical ultrasound and angiographic patterns. Choroidal metastasis is usually poorly circumscribed and can cause retinal detachments. They may have spicules of pigment on their surface. Unlike primary choroidal melanoma, they can grow quickly (weeks) and may require prompt treatment.

The patient with metastasis to the eye should also be examined by a medical oncologist. A complete metastatic survey should be performed to "stage" the patient (to see if there are other tumors within the body). Specifically, computed radiographic imaging of the brain and lung should be performed due to a high concurrent incidence of intracranial and pulmonary metastases. Dr. Saurin may suggest a total body PET/CT with fusion.

Treatments

The care of patients with metastasis to the eye typically involves cooperation between Dr. Saurin, a medical oncologist, and radiation therapist. Though chemotherapy can be used in many cases of orbital and choroidal metastasis, radiation therapy is usually a more definitive treatment. If the metastatic tumor has not destroyed the center of the retina, early treatment offers the best hope for preserving vision. Almost all patients with choroidal metastasis can be treated with external beam radiation. That is, surgery is rarely needed as treatment for choroidal metastasis.

Most patients who develop posterior choroidal metastasis can either be closely monitored for tumor growth, followed for response to chemotherapy, or treated with external beam irradiation. Radioactive plaque radiotherapy is rarely needed. If chemotherapy is not an option, prompt external beam irradiation (typically 30-40 Gy), may offer the best chance for preservation of vision.

In those rare cases where the metastasis spreads to the iris, patients can develop severe glaucoma and may lose their eye. Thankfully, anterior segment (iris) metastases are rare. Since most cancers do not spread to the iris, most patients with intraocular, choroidal and orbital metastasis respond well to treatment and keep their vision.

These common forms of ocular cancers and hundreds of other less common forms can be treated by Dr. Saurin with an evaluation and subsequent surgery. If you are looking for an expert in diagnosing, evaluating and treating your ocular cancer, look no further than The Eye Plasty Center. Remember, cancer can kill! Evaluating a lesion suspiciously right at the beginning and regular eye check ups can save your life.