背景:目的是描述北欧的治疗实践,并达成北欧关于皮脂腺眼睑癌治疗的共识。
方法:通过向北欧眼整形外科医生提供37个问题的问卷收集治疗实践数据并进行分析。进行PubMedMEDLINE数据库搜索以收集有关已发布的治疗实践和建议的数据。分配了一个工作组,该工作组由来自每个领先的北欧大学眼科医院的至少一名高级顾问组成。使用结构化交互方法来建立共识。
结果:24名医生回答了问卷。23/24(96%)的受访者在手术前进行了活检。14/23(61%)常规进行区域淋巴结扫描,13/23(57%)常规进行转移性疾病的全身筛查。6/22(27%)从未进行结膜标测活检,12/23(52%)从未进行过Muir-Torre筛查。受访者使用了莫氏手术,冷冻切片或延迟闭合的多阶段切除,5-6毫米是最优选的边缘。前哨淋巴结活检是9/22(41%)的可能选择,而冷冻疗法和丝裂霉素C是6/22(27%)的受访者。50%的受访者认为辐射是一种治疗选择。15/16(94%)受访者总是随访他们的患者,最多5年。在随访期间,三分之二的区域淋巴结扫描。代表三个领域的18个陈述达成了共识:术前检查,治疗和随访。
结论:五个拥有相似公共卫生保健系统的北欧国家的治疗实践有所不同。在本文中,作者提出了治疗眼睑皮脂腺癌的北欧共识。
BACKGROUND: The purpose was to describe the Nordic treatment practices and to reach a Nordic
consensus for the treatment of sebaceous eyelid carcinoma.
METHODS: The treatment practices data was collected by a questionnaire with 37 questions to the Nordic oculoplastic surgeons and analyzed. A PubMed MEDLINE database search was done to gather data on the published treatment practices and recommendations. A working group that consisted of in minimum one senior consultant from each leading Nordic University Eye Hospital was assigned. A structured interactive method was used to establish the
consensus.
RESULTS: Twenty-four doctors responded to the questionnaire. 23/24 (96%) of the respondents took a biopsy before surgery. Regional lymph node scanning was routinely done by 14/23 (61%) and a systemic screening of a metastatic disease by 13/23 (57%). 6/22 (27%) never took conjunctival mapping biopsies and 12/23 (52%) never screened for Muir- Torre. Respondents used Mohs surgery, frozen section or multi-stage excision with delayed closure, and 5-6 mm was the mostly preferred margin. Sentinel lymph node biopsy was a possible option for 9/22 (41%) and cryotherapy and Mitomycin C for 6/22 (27%) respondents. 50% of respondents considered radiation as a treatment option. 15/16 (94%) respondents always followed-up their patients, most for 5 years. Two thirds scanned regional lymph nodes during the follow-up.
Consensus was reached for 18 statements representing three domains: preoperative work-up, treatment and follow-up.
CONCLUSIONS: Treatment practices differ in between the five Nordic countries which have similar public health care systems. In the article the authors present a Nordic
consensus for the treatment of eyelid sebaceous carcinoma.