The pattern of lymphatic metastasis of malignant
tumors in the periorbital area
Han-Sin Jeong, MD, Young-Ik Son, MD, PhD, Chung-Hwan Baek, MD, PhD
T
Department of Otolaryngology – Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
Abstract Background and objectives: The rarity of malignant tumors in the periorbital area makes it difficult
to assess the patterns of lymphatic spread and to determine the optimal extent of treatment. The
objective of this study was to analyze the patterns of lymphatic metastasis in malignant tumors
arising from the periorbital area according to the primary site and to assess the optimal extent of
surgical treatment for these tumors.
Materials and methods: We retrospectively reviewed the medical records of 8 patients with
malignant tumors in the periorbital area from January 1997 to June 2002. The mean duration of
follow-up was 27.5 months. Five primary tumors were located in the medial half of the periorbital
area, 2 tumors in both medial and lateral halves, and 1 tumor in the lateral half. The pathological
diagnoses were 3 squamous cell carcinomas, 2 adenoid cystic carcinomas, 2 sebaceous carcinomas,
and 1 basal cell carcinoma.
Results: The lymphatic metastasis was observed in 4 of 8 patients who had a relatively large
( z 4 cm) primary tumor or poorly differentiated tumor. Four of 7 tumors involving the medial half of
the periorbital area exhibited lymphatic spread to the periparotid lymph node and level II cervical
lymph node groups.
Conclusion: The results of this study suggest that more aggressive management of the parotid area is
necessary in malignant tumors arising from the periorbital area, even in the medial half of the
periorbital area.
D 2006 Elsevier Inc. All rights reserved.
1. Background and objectives
The periorbital area contains multiple organs: the upper
and lower eyelid with their appendages, the lacrimal gland,
and the nasolacrimal gland. The most common patholo-
gical diagnosis of malignant tumors from the periorbital
area is squamous cell carcinoma, followed by adenocarci-
noma and malignant melanoma, with basal cell carcinoma
and malignant lymphoma occurring rarely [1,2].
The rarity of malignant tumors in this area makes it
difficult to assess the patterns of lymphatic spread and re-
currence, and to determine the optimal extent of treatment.
Anatomical studies have shown that the medial half of
the periorbital area drains first to submandibular lymph
node groups and that the lateral half drains to parotid
lymph node groups [3]. However, the clinical correlations
are lacking.
In this paper, we aimed to identify the patterns of
lymphatic metastasis in malignant tumors arising from the
periorbital area according to the primary site and to assess
the optimal extent of surgical treatment for these tumors by
analyzing retrospectively 8 cases of malignant tumors in
the periorbital area.
2. Materials and methods
Eight patients who had been treated at Samsung
Medical Center from January 1997 to June 2002 with
histologically verified malignant tumors in the periorbital
area were enrolled for this study. Their ages at diagnosis
ranged from 43 to 76 years with a mean of 59 years. The
male/female ratio was 4:4. The duration of follow-up
ranged from 14 to 44 months with a mean of 27.5 months.
We retrospectively reviewed the clinical courses and
0196-0709/$ – see front matter D 2006 Elsevier Inc. All rights reserved.
doi:10.1016/j.amjoto.2005.05.010
T Corresponding author. Tel.: +82 2 3410 3579; fax: +82 2 3410 3879.
E-mail address: chbaek@smc.samsung.co.kr (C.-H. Baek).
American Journal of Otolaryngology –Head and Neck Medicine and Surgery 27 (2006) 5 – 8
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