We read the article on malignant tumors of the eyelid in India with great interest. Variation in the type of eyelid malignancy is linked to the skin color and location from equator. The multicentric collaboration of the authors to circumvent the bias resulting from the vast terrestrial extent and diverse pigmentation in India is applaudable.
Sebaceous cell carcinoma (SGC) was found to be the most common lid cancer in India. The metastasis and local recurrence in SGC is mostly seen within the first 2 years after the initial treatment. However, the aggressive behavior and the possibility of delayed recurrence in SGC warrants observation every three months for a year, every 6 months for 3 years, and every year thereafter. The mean follow-up in this study was 21.44 months and in the analysis of distal metastasis, lymphatic spread, and recurrence, any patient with > three months of follow-up post excision were included. The shorter duration of follow-up in some of these cases could have resulted in underreporting of the adverse outcomes and lack of relationship between adverse outcomes with canthal involvement and dimension of the tumor.
Positron emission tomography (PET) or sentinel node biopsy (SNB) are indicated for tumor size >10 mm, canthal and anterior orbital extension, and signs of lymphatic invasion on histopathology. In the current study, none of patients underwent SNB. PET was performed in only 21 subjects, despite 42 SGC and 12 squamous cell carcinomas, being T2b or worse (AJCC 7th to edition), possibly contributing to metastasis in 14.5% cases despite margin clearance at surgery.
The study highlights the need for creation of a structured referral system with affordable investigations/treatment modalities to enable timely diagnosis and intervention for improvement of long-term cancer survival in India.
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