The main goal, in eyelid reconstruction, is to promote an adequate protection to the ocular globe, through the reconstitution of all anatomic plans. In order to obtain adequate stability, cartilage grafts are often used in the repair of the internal lamella. Cartilage grafts from auricular scapha in contact with the bulbar conjunctiva were used in this study. Nineteen patients with various pathologies had 20 eyelid reconstructions using this technique (10 cutaneous tumors, 7 post-traumatic, and 3 cases of lower eyelid retraction). Local cutaneous flaps (glabella, Mustard, etc) were used to reconstruct the external lamella. Epithelialization on the perichondrium (confirmed by the histological examination) occurs between 3 to 4 weeks. The functional and aesthetic result was considered good in 14 cases (70%), acceptable in 5 (25%) and poor in one case (5%). The donor area showed no complications or deformities. The shape of the scapha allows satisfactory conformation of the graft to the curvature of the ocular globe; it is not flat like the nasal septum, and has a smoother curvature than the auricular concha. Furthermore, it is thinner and that is another reason why the aesthetic result was superior to the technique previously used. The functional results were similar.

BACKGROUND:Primary cutaneous melanoma still constitutes the main cause of skin cancer death in developed countries, and its incidence in recent years has been increasing in a steady, worrisome manner.OBJECTIVES:This study evaluated the clinical, epidemiological and demographic aspects of this disease, and correlated them with patient prognosis.METHODS:Using epidemiologic and clinical data, we analyzed 84 patients with mild to severe primary cutaneous melanoma treated between 1990 and 2007. Slides containing surgical specimens were analyzed, and new slides were made from archived paraffin sections when necessary.RESULTS:The melanoma incidence was higher in areas of sun exposure, with lesions commonly observed in the trunk for males, and lower limbs for females. In addition to Breslow’s thickness and ulceration (p = 0.043 and p < 0.001, respectively), the mitotic rate per mm2 also correlated with worse patient outcome (p = 0.0007). The sum of ulceration (0 when absent or 1 when present), the Breslow index (1 when <1 mm, 2 when >1 mm and <4 mm, 3 when >4 mm) and the mitotic index (0 when absent or 1 when ≥1 per mm2) allowed the establishment of a prognostic score: if the sum was equal to or over three, nearly all (91.7%) patients had systemic disease. The 5-year survival was approximately seventy percent.CONCLUSION:Because American Join Committee of Cancer Staging will update the classification of malignant tumors (TNM) staging in the near future, and introduce mitosis as a prognostic factor, our results show the importance of such a feature. Additional studies are necessary to confirm the importance of a prognostic score as proposed herein.

Prolapse of the lacrimal gland is an acquired clinical condition caused mainly by relaxation of the local suspending ligaments. Before an aesthetic blepharoplasty, there should be a preoperative clinical suspicion of lacrimal gland pathology for patients with bulging lateral thirds of the upper eyelids. It should be borne in mind that inadvertent removal of the lacrimal gland can lead to important alterations in ocular lubrication. This report describes two clinical cases of patients with lacrimal gland prolapse associated with dermatochalasis and their treatment.

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It was found that the perichondrium had an important role in conjunctival epithelialization in eyelids reconstructed with a cartilage graft in the present study.