杨某某，男，26岁

Mr. Yang,26 years old, Male

一、病例特点

General Information

主诉

左眼下睑皮肤被灼热铁屑崩伤后溃疡7个月。

Chief complaint

There was an ulcer in the lower eyelid of the left eye after burned by a hot scrap iron 7 months ago.

病史

现病史：患者7个月前左眼下睑皮肤被灼热铁屑崩伤后形成溃疡，原下睑皮肤有一黑痣受累及，未具体诊疗，自行口服抗生素。后伤口处溃疡结痂，迁延不愈，为进一步治疗来我院。

既往史：患者自幼左眼下睑皮肤处黑痣，自外伤前止无明显变化（图1）。

家族史：无

Medical History

Present history: 7 months ago, the patient’s lower eyelid of the left eye was burned by a hot iron scrap and then ulcerated. After that, the lesions scabbed. So, he came to our hospital for further diagnosis and therapy.

Past history: The patient had a pigmented mole on the lower eyelid of the left eye at a very young age, and there was no change about it before this trauma.

Family history: No special history.

眼部检查

双眼视力1.0，眼压正常，前节及后节未见明显异常。

左眼：下睑中1/3处近睑缘处皮肤灰黑色结痂，质较韧，长约13mm，宽约3mm，表面凹凸不平，细小新生血管，鼻侧头端隐约可见黑痣，无内外翻及倒睫（图2）。

Ocular examinations

Vou: 1.0, IOP: normal, no obvious abnormalities about the eyeballs.

Left eye: lower eyelid, middle 1/3, closed to palpebral margin, grey black lesions, more toughened, 13×3mm, surface was irregularity and small new blood vessels. It seemed that there was a partial mole on the nasal part of the lesions. No ectropion, entropion and trichiasis.

二、初步诊断

Impression

左眼下睑肿物

左眼下睑陈旧皮肤烧伤

Tumor in the lower eyelid OS

Old burn of the lower eyelid OS

三、治疗经过及结果

Treatment and Preliminary Results

1.左眼下睑肿物部分切除（活检），术中见肿物触碰易出血，标本送检后病理结果回报为左眼下睑基底细胞癌；

2.左眼下睑肿物切除+睑裂缝合术，肿物边缘外5mm扩大切除，送检，病理结果回报左眼下睑基底细胞癌，切缘未见癌细胞（图3）。

1.A small part of the tumor was resected that was diagnosed as basal cell carcinoma by pathological examination, and during the operation, we found the tumor was easy to bleed when touching.

2.Resect tumor totallyexpanding 5mm along the edge of the lesionsandtarsorraphy. The result wasbasal cell carcinoma, and the edge was clean.

四、讨论

Discussion

朱利民主治医师：基底细胞癌通常发生于60岁以上人群，为眼睑最为常见的恶性肿瘤，随着其高发病率，已经成为一个重要的公共安全问题。目前，其病因仍不明确，但是一些证据显示其危险因素可能是身体与环境多因素共同作用的结果。但是，紫外线被认为是最重要的危险因素。其他可能的危险因素包括：放疗、免疫缺陷、烧伤、局部慢性炎症、溃疡等。基底细胞癌常发生于眼睛周围，如眉毛、眉间、眼角、眼睑等。大约5-10%的皮肤癌发生于眼睑。在上皮细胞来源肿瘤中，基底细胞癌相对于鳞状细胞癌来说更常见。本例患者就诊时，下睑肿物性质不明确，因此我们先行肿物活检，病理检查明确诊断以决定手术方案为单纯切除或扩大切除。另外，活检时，见灰黑色病灶触碰后极易出血，往往提示恶性可能性大。

Dr. Zhu Li-Min:Basal cell carcinoma typically affects patients over the age of 60 years. It is the mostcommon skin cancer with an increasing incidence worldwide,thereby imposing an important public health problem. Its etiology is still unclear, butexisting data indicate that the risk for its development is of multifactorial origin andresults from both constitutional and environmental factors. Yet, UV radiation isbelieved to be the predominant causative risk factor in the pathogenesis of basal cellcarcinoma, and possible risk factors including radiotherapy,immunodeficiency, burn injury, local chronic inflammatory, ulcer and so on.It frequently occurs in the periocular region (eyebrows, glabella,ocular canthi, and eyelids). Approximately 5–10% of all skincancers occur in the eyelid. Considering epithelial tumors (90% of malignant eyelidtumors), basal cell carcinoma is much more frequent if compared to squamous cellcarcinoma. The diagnosis of this present patient was not clear when he came to our hospital, so firstly, we took the operation of partial tumor resected that was confirmed by pathological examination, and then, according to the result of it, we decided the plan only resection or expanded resection. In addition, during the first operation, the lesion was easy to bleed when touching. Usually, it indicates that this tumor is not benign.

何彦津主任医师：我们知道基底细胞癌最常见的原因为紫外线照射，其他原因包括外伤，炎症等。但查找中外文献未见有关外伤刺激导致基底细胞癌发生的确切证据或报道。本例患者自幼下睑黑痣，此次外伤前黑痣无明显增大或疼痛、红肿、瘙痒等不适。热铁屑灼伤后黑痣处组织破溃结痂、不愈。烧伤致其癌变的过程明确，是非常有意义的病例。另外，基底细胞癌多见于中老年人，而本例26岁，青年男性，更新了我们对于基底细胞癌的认识。对于手术方案，因患者年纪较轻，病灶较大，接近睑缘，且术中沿肿物边缘再扩大5mm切除，恐皮瓣移植瘢痕愈合影响外观，故手术将肿物切除后上睑板上唇与下睑结膜缘对位，缝合睑裂，待半年后再行眼睑重建术。

Dr. He Yan-Jin: As we all known, the most common factor of basal cell carcinoma is UV, and the other risk factors include trauma, inflammatory and so on. But, there was a little exact evidence about these trauma factors by checking Chinese and foreigndocuments. The present patient, when he was a child there was a mole in his lower eyelid of left eye, and no enlargement, no pain, no red and no pruritus before this trauma. Ulceration formed after hot iron. Trauma as a factor leads to the mole transform to basal cell carcinoma is exact. This is a significance case. Moreover, because the patient is young, lesion is big, closed to palpebral margin, and expanded resection, we afraid that skin flap transplantation will lead to serious scar that affect appearance obviously. In the end, we choose tumor resection combined with tarsorraphy, and eyelids will be separated after half a year.

图1外伤前：左眼下睑色素痣

图2外伤后：下睑灰黑色病灶，表面凹凸不平

图3 术后：睑裂缝合