Abstract

DO.19.07

The underestimated depth of tissue invasion of Xanthelasma – A histological study

Mittelviefhaus H., Kreusser C., Auw-Hädrich C.
Universitäts-Augenklinik Freiburg

Objective: The depth of tissue invasion of xanthelasma is of major importance in selecting the most suitable surgical procedure. Intraoperative findings let assume, that despite common presumption xanthelasma are not limited to the superior dermis but that they may penetrate the entire dermis and reach into the orbicularis muscle. In this study the depth of tissue invasion of xanthelasma was measured in histological specimens.
Methods: Between 1996 and 2006 99 xanthelasmata of 78 patients were surgically removed. Histological specimens were examined by light microscopy and the depth of tissue invasion by fat containing macrophages was measured using the digital picture analysis system AnalySIS^® of Soft Imaging System Inc. The distance from the epidermis/dermis junction to the deepest „xanthelasma“cell was measured. In addition we classified the cases in 3 categories: 1) invasion into the dermis, 2) invasion down to and 3) invasion into the stratum muscularis.
Results: The thickness of the xanthelasmata ranged between 269.0 mm und 2118.8 mm (m=917.7 mm). In 63 of 99 specimens (63.1%) lipid deposites infiltrated the dermis (m=920 mm), in 27 specimens (27.3%) they reached the stratum muscularis (m=1.191.9 mm) and in 9 specimens (9.1%) they even infiltrated this layer (m=1.447.8 mm). In 18% of the patients a dyslipidemia was known at the time of the initial visit. 40% of these patients had xanthelasmata of all four eyelids, compared to only 9.4% of patients without dyslipidemia. Recurrences were observed in 42.9% of patients with dyslipidemia in contrast to 31.7% of patients without dyslipidemia. However, the difference was not significant.
Conclusions: This study confirms our hypothesis, that a significant part, namely 36.4% of the xanthelasmata infiltrates the entire dermis and reaches the stratum muscularis or even invades into this layer. These xanthelasmata should not be treated by superficial laser therapy but should be better excised surgically.

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