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Dr. Rick
Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 7922
Experience:  Ophthalmology since 1994 with Retina sub-specialty interest
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I have been operated once in my left eye upper lid and left

Resolved Question:

I have been operated once in my left eye upper lid and left eye orbit for basal cell carcinoma (I have trichoepitelioma in my face. I had it in my left eye eyebrow, that was also removed). I have been offered "exenteration" which I don't accept. I having had radiation, nor drug treatment nor chemo. I am looking for a viable solution, maybe proton radiation or other treatment. Actually I can see from the left eye even that the doctor took out one muscle. With the two eye I can see, but I see a little double. I am willing to send all medical examens I have. Please advice as soon as possible if I can be attended at Mayo Clinic. Please send international patient appointment form because I am from Panama. Male 67 years of age. I need HELP, S.O.S. Thanks,XXX@XXXXXX.XXX
Submitted: 2 years ago.
Category: Eye
Expert:  Dr. Rick replied 2 years ago.

Dr. Rick :

Hi. I'm online and happy to answer your question today.

Dr. Rick :

So. Am I to understand the cancer has spread into your orbit? How is your vision in that eye?

Customer:

I have basal cell carcinoma in the orbit of my left eye that was operated once in Memphis, TN. I am from the Republic of Panama. Other ophtahlmologist recommeded exenteration. I will like to see if at Mayo Clinic there is another possibility than exenteration.

Customer:

yes it is in the orbit (perineural invasion)

Dr. Rick :

That, as you know, is not a good thing. The basal cell can spread to your brain along the nerve and then.........only bad things from that point on.

Customer:

I can see with the left eye. I use GenTeal. With the 2 eye I see a little double because once muscle was removed.

Dr. Rick :

If you are wanting to come to the USA for treatment I would also recommend Wills Eye Hospital in Philadelphia. Dr's Shield (husband and wife team) are the Worlds experts on ocular tumors. That is where I would go if I was in your boat.

Customer:

Doctor, I have been to Hamilton Eye Institute were I was operated in February 2011 (february, may and august 2011), I have been to Bascom Palmer in Miami (doctor told me I knows the doctor at Hamilton son do not come back and see me), I was a MD Andrson (after examinations the recommended exenteration or clinical trial), I was a Massachusetts Eye and Ear (after review of medical records they recommend exenteration).

Customer:

I FORGOT, I was also at Florida University Proton Center, they recommended exenteration.

Dr. Rick :

You have been treated by some of the best experts in the world for your condition. As a retina specialist myself I agree......you should have your orbit exenterated to save your life.

Dr. Rick :

I wish there was another choice but if you don't do this and it spreads to your brain you will, most likely, die.

Customer:

I was also at Franacis Burr Proton Center in Boston, Mass. The doctor is reviewing my case to see what can be done. Remember doctor, my left eye is OK, I can see, it moves around a little, I can recognize colors, etc.

Dr. Rick :

Yes. And that is what makes taking out the eye and all orbital contents so very, very difficult. However, if this cancer is tracking along the nerves toward your brain and you wait until you have lost all vision from invasion into your optic nerve it may be too late for surgery to get the all the cancer.

Customer:

What is your opinion about Mayo Clinic at Jacksonville, Florida. I have been told that they attend difficult problems.

Dr. Rick :

Yes. You are correct. But they are no better then Bascom Palmer or Mass Eye and Ear

Customer:

Can pencil bean proton therapy be an option?

Customer:

Exenteration is to bad for me. I am a professor at the Universidad de Panama. I am a certified public accountant an attorney at law. I need my EYE:

Dr. Rick :

Then you understand that you will have the other one. If it gets to your brain practicing law and teaching at the University will be over. I understand how you are feeling. I would recommend seeing Dr. Jerry Shields at Wills Eye Hospital if you had not already been to some of the very top programs in the world. I, truly, don't think Dr. Shields will tell you anything different.

Dr. Rick :

You have a very serious problem and, I'm afraid, it is going to require you to sacrifice an eye. I must admit -- I'm not sure I could do it either.

Customer:

Is surgery to remove the cancer and then radiate the orbit is a possibility?

Dr. Rick :

Are you still there?

Dr. Rick :

Yes. That is a possibility. For that I would see Dr. Shields at Wills Eye Hospital.

Customer:

Since I had only one surgery in the orbit (Feb 2011), maybe a second surgery and then radiation could be an option?

Dr. Rick :

here is a link to Wills:

Dr. Rick :

http://www.willseye.org/

Dr. Rick :

Yes, that is a possibility. However, as an educated man yourself, you fully understand that if experts feel exenteration is the best option any delay could make exenteration ineffective.

Customer:

You know doctor, no one in Panama told me I had BCC, but at Memphis I ask for radiation, the doctor didn't accept. I think that up to this momento, with do respect, my problem is not ophthalmology, it is an oncology problem. What about the readiation center at Willis Eye?

Dr. Rick :

Yes. They have a great relationship with the radiation/oncology department where all types of orbital and ocular tumors are evaluated and treated. I think you would be very pleased with the care you get there.

Customer:

Doctor, I can recall from our conversation that I am in a Loss Loss game, notwithstanding, I am going to continue and see the people at Willis Eye as soon as possible. I know I don't have much time.

Dr. Rick :

That sounds like an excellent plan. I am sorry that you are in this position and I hope things work out the best for you. Take care.

Dr. Rick :

And, now, the obligatory word from our sponsors: :o)


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Dr. Rick :

Let me know if there are there any other concerns or issues you would like to discuss on this topic.


 


If you have a chance drop me a note and let me know how things turn out. You can post to this thread or ask for me at the main screen at no additional charge.


 

Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 7922
Experience: Ophthalmology since 1994 with Retina sub-specialty interest
Dr. Rick and 2 other Eye Specialists are ready to help you
Expert:  Dr. Rick replied 2 years ago.
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Expert:  Dr. Rick replied 2 years ago.
I will be thinking positive thoughts for you :)

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