Pharmacological cytoreduction and sliding skin graft (h-plasty) for bilateral lower-eyelid squamous cell carcinoma in a pony

Purpose. To describe the surgical approach to a bilateral lower eyelid squamous cell carcinoma (SCC) in a pony. Methods. A 9 year old mare, Connemara Pony, light hair, presented for a bilateral lower-eyelid infiltrating mass. No diagnostic test was performed and a bilateral SCC was suspected. The neoplasia invaded 50% of the length of the lower-eyelid in both eyes, including the medial cantus in the left one. Because of new promising approaches to SCC (Hyperthermia, Brachytherapy, Photodynamic therapy) as well as most immunotherapy and chemotherapy molecules were not available, palpebral surgery was considered. Due to the size of the lesions, a pre-surgical cytoreduction was performed by using Piroxicam 0,3mg/kg/24 hours PO associated to local application of Imiquimod cream 3 times a week for 3 weeks. Slight reduction of the lateral portion of the mass was noted in both eyes, and surgical approach with H sliding skin graft was performed under general anesthesia. Lower lacrimal punctum in left eye was sacrificed, but the canaliculus was cannulated for one month. Tobramycin ointment was given topically after surgery q 6 h OU until healing occurred and systemic antibiotics and non-steroidal antiinflammatory (Flunixin M.) were administered for 7 days. cells. Results. Hystopathology confirmed the diagnosis of bilateral SCC infiltrating lower eyelid and the surgical margins appeared free from neoplastic cells. A normal palpebral function was maintained bilaterally; no recurrence was noticed 2 years after surgery. Conclusions. Whenever a new approach to palpebral SCC is not available, cytoreduction associated to surgery can be considered