title: Glasses: Hiding or causing skin cancer?
abstract: This article evaluates malignant transformation of lesions presenting in the periocular skin under the eye spectacle nose pad. A non-comparative retrospective chart review of clinical features and pathological findings of patients presenting with periocular malignancies in the exact vicinity where the nose pads of their eye spectacles rested was completed. The study took place in one tertiary oculoplastic referral center between 2007-2013. Ten patients were included, six of whom were male. All subjects wore eye spectacles while awake for at least 15 years, and had an evident suspicious lesion in the exact area that coincided with the resting place of the nose pad. The mean age was 73.5 years (range 65-85 years) and all patients had the lesion present for at least one year. Most cases were squamous skin malignancies (five squamous cell carcinomas [SCC], 2 intra-epidermal carcinomas [IEC], while 3 basal cell carcinomas [BCC]). Treatment involved surgical excision of the lesion with frozen section for margin control and reconstruction with a myocutaneous flap. Periocular malignancies of the inferior medial canthal area, where the nose pad of eye spectacle places pressure, can be easily missed or misdiagnosed. Marjolin ulcers (MU) classically present as an aggressive SCC in area of chronic inflammation, which has been previously correlated to constant pressure, repetitive trauma, or non-healing wounds in other areas of the body. We propose that the traumatic chronic pressure in the infero-medial canthal region from long-term eye spectacle nose pad use, may induce poor lymphatic regeneration leading to an immune system deficiency that predisposes this skin to a malignant transformation. The presence of chronic eye spectacle nose pads also prevents proper and timely detection of such malignancies. Complete excision of these lesions with margin control, adequate follow-up for possible recurrence, and surveillance for new lesions on the patient's contralateral side, is crucial for adequate management.
authors.affiliation: a Department of Ophthalmology , Tulane University, Tulane Health Sciences Center , New Orleans , Louisiana , USA.
authors.forename: Ze
authors.initials: Z
authors.lastname: Zhang
authors.affiliation: a Department of Ophthalmology , Tulane University, Tulane Health Sciences Center , New Orleans , Louisiana , USA.
authors.forename: Soroosh
authors.initials: S
authors.lastname: Behshad
authors.affiliation: a Department of Ophthalmology , Tulane University, Tulane Health Sciences Center , New Orleans , Louisiana , USA.
authors.forename: Pooja
authors.initials: P
authors.lastname: Sethi-Patel
authors.affiliation: a Department of Ophthalmology , Tulane University, Tulane Health Sciences Center , New Orleans , Louisiana , USA.
authors.forename: Alejandra A
authors.initials: AA
authors.lastname: Valenzuela
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002278:Carcinoma in Situ / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D002280:Basal Cell Carcinoma / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D002294:Carcinoma, Squamous Cell / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D005139:Eyeglasses / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D009666:Nose; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000209:etiology* / Q000473:pathology / Q000601:surgery
keywords: Marjolin ulcer; glasses; nose pad pressure; periocular skin malignancy; squamous cell carcinoma