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Facial Implants - Part 1

1:01:52 recording · EN · 5 speakers

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Brief overview

Targeted and immune therapies now spare eyes and orbits in periocular cancer, making multidisciplinary care the standard.

  1. Send the tissue, and send enough of itNon-diagnostic superficial biopsies frustrate everyone; recurrent chalazia have come back as sebaceous carcinoma, so photograph the lesion, avoid cautery, and biopsy at the margin.
  2. Immunotherapy spares radiation and exenteration in perineural spreadWhere high-dose radiation to the skull base once guaranteed blindness, PD-1 checkpoint inhibitors gave Michigan roughly 85% two-year survival with returning cranial nerve function.
  3. Rare ocular cancers need an ocular oncologist following themSebaceous carcinoma and conjunctival melanoma metastasize during follow-up half the time and are routinely misclassified by general medical oncologists.
Executive Summary AI
  • Host Leelangi Yedere-Wikrama convenes four ocular oncology specialists — Dr. Howard Kaufman, Dr. Bidas Meili, Dr. Hakan Demirci and Dr. Natalie Wolkoff — to cover periocular oncology from diagnosis through long-term surveillance.1:48
  • The panel calls targeted and immune-directed therapy from about 2011 to 2012 the decade's biggest change, alongside eye-sparing radiation and topical drugs, with patients now keeping eyes they would once have lost.3:39
  • Dr. Natalie Wolkoff's biopsy rules: build a differential before cutting, take photos, take enough tissue, avoid cautery and crush artifact, and excise deeper when melanoma is suspected because tumor thickness drives sentinel node decisions; Dr. Hakan Demirci adds biopsying at the lesion margin rather than an ulcerated, necrotic center.5:43
  • Drug therapy is reserved for locally advanced disease — by AJCC, T4 greater than 30 millimeters and invading the orbit — cases otherwise facing exenteration, and stage three melanoma with nodal metastasis, since surgery already cures most periocular cancers.17:18
  • For perineural spread Dr. Hakan Demirci's Michigan group treats one year and reports about 85% survival at two years and 75% at three, against radiation at 66 grays that relieved pain but left patients blind; Dr. Howard Kaufman adds a median time to response near 1.9 months in cutaneous squamous cell and doubled Merkel cell survival over the decade.31:48
Key Quote
“As pathologists, we really don't care if you're right or wrong, but the information that's on the sheet is really helpful.”
— Dr. Natalie Wolkoff10:08
Key Quote
“So please send it to the pathology.”
— Dr. Hakan Demirci12:57
Key Quote
“So, we definitely know that overall, the survival for Merkel cell patients has doubled over the last decade, largely due to the introduction of immunotherapy.”
— Dr. Howard Kaufman39:15