Tommy Supit1, Trilaksana Nugroho2, Alifiati Fitrikasari3. 1. Department of General Surgery, Faculty of Medicine Diponegoro University, Dr. Kariadi General Hospital, Jl. Dr. Sutomo No. 16, Randusari, Semarang Selatan, Semarang, Jawa Tengah, 50244, Indonesia. 2. Department of Ophthalmology, Faculty of Medicine Diponegoro University, Dr. Kariadi General Hospital, Jl. Dr. Sutomo No. 16, Randusari, Semarang Selatan, Semarang, Jawa Tengah, 50244, Indonesia. 3. Department of Psychiatry, Faculty of Medicine Diponegoro University, Dr. Kariadi General Hospital, Jl. Dr. Sutomo No. 16, Randusari, Semarang Selatan, Semarang, Jawa Tengah, 50244, Indonesia.
Abstract
INTRODUCTION: and importance: Conjunctival melanoma (CM) is a rare and potentially lethal ocular tumor. As with any oncologic disease, early diagnosis and appropriate treatment of CM is paramount to limit morbidity and increase life expectancy. However, patients with severe mental disability with social isolation are usually presented in late-stage disease. CASE PRESENTATION: This report presents a case of a 55-year-old man with paranoid schizophrenic man with an extraordinarily large CM due to neglect. The patient suffered from complete left eye blindness with no clinical and radiological evidence of metastasis. CLINICAL DICUSSION: Clinicians must bear in mind the limited patient compliance and family support of mentally-ill patients that restricts treatment modalities that would have otherwise been applicable for cooperative patients. The importance multidisciplinary approach, choosing the simpler but effective surgical technique should be prioritized. INTERVENTION AND OUTCOME: Left exenteration and tumor wide excision was performed. The left orbital defect was reconstructed using forehead flap and split-thickness skin graft (STSG). The uncooperative nature of the patient posed early post-operative challenges that necessitates subsequent operation to drain seroma. The patient was discharged 16-days after operation with acceptable cosmetic and clinical results. However, the patient failed to return to the clinic for longer post-operative evaluation. CONCLUSION: A multidisciplinary approach is mandatory to treat complex cases such as this report. Surgeons are advised to adopt simpler surgical approach that will require minimal self-care and should encourage family members to continuously support the patient.
INTRODUCTION: and importance: Conjunctival melanoma (CM) is a rare and potentially lethal ocular tumor. As with any oncologic disease, early diagnosis and appropriate treatment of CM is paramount to limit morbidity and increase life expectancy. However, patients with severe mental disability with social isolation are usually presented in late-stage disease. CASE PRESENTATION: This report presents a case of a 55-year-old man with paranoid schizophrenic man with an extraordinarily large CM due to neglect. The patient suffered from complete left eye blindness with no clinical and radiological evidence of metastasis. CLINICAL DICUSSION: Clinicians must bear in mind the limited patient compliance and family support of mentally-ill patients that restricts treatment modalities that would have otherwise been applicable for cooperative patients. The importance multidisciplinary approach, choosing the simpler but effective surgical technique should be prioritized. INTERVENTION AND OUTCOME: Left exenteration and tumor wide excision was performed. The left orbital defect was reconstructed using forehead flap and split-thickness skin graft (STSG). The uncooperative nature of the patient posed early post-operative challenges that necessitates subsequent operation to drain seroma. The patient was discharged 16-days after operation with acceptable cosmetic and clinical results. However, the patient failed to return to the clinic for longer post-operative evaluation. CONCLUSION: A multidisciplinary approach is mandatory to treat complex cases such as this report. Surgeons are advised to adopt simpler surgical approach that will require minimal self-care and should encourage family members to continuously support the patient.
Authors: Swarup S Swaminathan; Matthew G Field; David Sant; Gaofeng Wang; Anat Galor; Sander R Dubovy; J William Harbour; Carol L Karp Journal: JAMA Ophthalmol Date: 2017-12-01 Impact factor: 7.389