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Klin Monbl Augenheilkd 2018; 235(10): 1138-1147
DOI: 10.1055/s-0043-111799
Übersicht
Georg Thieme Verlag KG Stuttgart · New York

Aktuelle Therapiekonzepte bei oberflächlichen malignen Tumoren

Current Therapies in Superficial Malignant Tumors
Simone Luisa Scholz
1   Zentrum für Augenheilkunde, Universitätsklinikum Essen, Essen
,
Anja Eckstein
2   Orthoptik, Universitäts-Augenklinik Essen, Essen
,
Dirk Dekowski
2   Orthoptik, Universitäts-Augenklinik Essen, Essen
,
Joachim Esser
2   Orthoptik, Universitäts-Augenklinik Essen, Essen
,
Henrike Westekemper
1   Zentrum für Augenheilkunde, Universitätsklinikum Essen, Essen
,
Klaus P. Steuhl
1   Zentrum für Augenheilkunde, Universitätsklinikum Essen, Essen
› Author Affiliations
Further Information

Publication History

eingereicht 02 February 2017

akzeptiert 24 April 2017

Publication Date:
12 September 2017 (online)

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Zusammenfassung

In dieser Übersichtsarbeit werden die diagnostischen und therapeutischen Möglichkeiten bei den häufigsten malignen oberflächlichen Tumoren abgehandelt, hierzu gehören Basalzellkarzinome, konjunktivale Lymphome, Plattenepithelkarzinome und maligne Melanome und deren Vorstufen. Entscheidend für die richtige Diagnostik und Therapie ist eine ausführliche Anamnese, Spaltlampenuntersuchung und Fotodokumentation des Tumorbefunds. Aber auch regelmäßige Kontrollen nach erfolgter Therapie sind unabdingbar.

Das Basalzellkarzinom ist der häufigste Tumor der periokulären Haut. Histologisch werden 3 Subtypen (nodulär, superfiziell, Morpheatyp) unterschieden. Eine vollständige Exzision mit entsprechendem Sicherheitsabstand ist immer anzustreben.

Das Lymphom ist der häufigste maligne primäre Tumor der Augenhöhle und der okulären Adnexe. Es kann sowohl primär als auch sekundär, im Rahmen einer lymphatischen Systemerkrankung, als auch ein- oder beidseitig auftreten. Das MALT-Lymphom (MALT: Mucosa associated lymphoid tissue) betrifft am häufigsten die Konjunktiven mit 20 – 33%. Therapeutisch wird standardmäßig eine perkutane Bestrahlung des Tumors angewandt.

Die Plattenepithelkarzinome der Bindehaut und deren Vorstufen (CIN I – III) stellen ebenfalls eine der häufigsten Tumorentitäten am Auge dar. Eine vollständige Tumorexzision ist immer anzustreben, jedoch aufgrund der häufig großflächigen Ausbreitung nicht möglich. Für eine gute Tumorkontrolle sind nach R1-Resektion daher adjuvante Therapien mit Mitomycin C (MMC) oder eine Radiotherapie mit Rutheniumapplikator oder Protonenbestrahlung notwendig.

Das Bindehautmelanom ist selten, es kann jedoch lebensbedrohlich sein. Die primär erworbene Melanose (PEM) mit Atypien (PEM I – III) hat je nach Schweregrad ein erhöhtes Entartungsrisiko, dies macht eine Therapie mit Mitomycin-C-Augentropfen notwendig. Bei Verdacht auf einen malignen Prozess ist immer eine Exzision mittels Non-Touch-Technik anzustreben, damit das Streuungsrisiko von Tumorzellen gering bleibt. Zusätzlich ist, abhängig von Lokalisation und Ausbreitung eines Melanoms, immer eine adjuvante Therapie mittels Rutheniumapplikator oder Protonentherapie notwendig.

Abstract

This article is a review of diagnostic and therapeutic possibilities in common epibulbar malignant tumors, such as basal cell carcinoma, conjunctival lymphoma, squamous cell carcinoma and conjunctival melanoma. Most importantly, for every tumor patient there is a detailed anamnesis, split lamp examination and photo documentation. Further regular controls after therapy are required due to the risk of recurrences.

Basal cell carcinoma is the most common tumor of the periocular skin, divided into three subtypes (nodular, superficial and morphea). The treatment consists of total excision with a sufficient safety margin.

The most common tumor of the orbital and ocular adnexa are lymphoma. They can appear primary or secondary, as lymphatic system disease. The gold standard therapy is a percutaneous irradiation.

Squamous cell carcinoma and its precancerous stages (CIN I – III) are frequently diagnosed on the conjunctiva. A complete tumor excision is required, but sometimes it is not possible due to large tumor growth. Therefore, an adjuvant therapy with mitomycin C eyedrops, brachytherapy with ruthenium plaque or proton radiotherapy is required.

Conjunctival melanoma is a rare, but life-threatening disease. Melanosis with atypia has a high risk for degeneration and requires further treatment with mitomycin C eyedrops. In cases of malignant tumor growth, an excision with a non-touch technique and adjuvant therapy with brachy or proton irradiation should be applied.

Schlüsselwörter

okuläre Tumoren - Bindehautmelanom - Basaliom - konjunktivales Lymphom - Plattenepithelkarzinom

Key words

ocular tumors - basaliom - conjunctival melanoma - conjunctival squamous cell carcinoma - conjunctival lymphoma
 

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