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Predictors of Local Recurrence for Eyelid Sebaceous Carcinoma

Questionable Value of Routine Conjunctival Map Biopsies for Detection of Pagetoid Spread

Sa, Ho-Seok M.D., Ph.D.*,†; Tetzlaff, Michael T. M.D., Ph.D.; Esmaeli, Bita M.D., F.A.C.S.*

Ophthalmic Plastic & Reconstructive Surgery: September/October 2019 - Volume 35 - Issue 5 - p 419–425
doi: 10.1097/IOP.0000000000001343
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Purpose: To identify clinicopathologic factors associated with local recurrence of eyelid sebaceous carcinoma and determine whether routine conjunctival map biopsies are necessary to detect pagetoid spread.

Methods: The authors searched PubMed for articles on eyelid sebaceous carcinoma and pagetoid spread published in English during 1982 to 2018, and they reviewed 99 consecutive patients with eyelid sebaceous carcinoma who underwent surgical excision with frozen section control of margins performed by 1 author (BE) during 1999 to 2017.

Results: Local recurrence rates after surgery were 5% to 25% in the literature and 6% in the authors’ cohort. Risk factors for local recurrence included T3b (>20 mm) or worse disease according to the AJCC Cancer Staging Manual, eighth edition, pagetoid spread, diffuse growth pattern, and multicentric origin. Pagetoid spread was observed in 8.3% to 70% of patients in the literature and 31% of patients in the authors’ cohort. The literature review showed that surgical excision with frozen section control is the mainstay of management of eyelid sebaceous carcinoma, with topical chemotherapy and cryotherapy used in cases with pagetoid spread. The authors found no solid evidence for added value from routine 4-quadrant conjunctival map biopsies, and some studies called into question their accuracy and yield.

Conclusions: In patients with eyelid sebaceous carcinoma, meticulous microscopic margin control is appropriate in all cases and particularly for tumors >20 mm and adjuvant topical chemotherapy should be considered for tumors with conjunctival pagetoid spread. Routine conjunctival map biopsies are not essential, but targeted map biopsies of areas with signs suggestive of pagetoid intraepithelial spread may be appropriate to guide future closer observation or adjuvant treatments.

For patients with eyelid sebaceous carcinoma, routine 4-quadrant conjunctival map biopsies have limited value, but targeted map biopsies of areas with signs suggestive of pagetoid spread, such as injection and neovascularization, may be appropriate.

*Orbital Oncology and Ophthalmic Plastic Surgery, Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, U.S.A.

Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, U.S.A.

Accepted for publication January 25, 2019.

The authors have no financial or conflicts of interest to disclose.

Address correspondence and reprint requests to Bita Esmaeli, M.D., F.A.C.S., Orbital Oncology and Ophthalmic Plastic Surgery, Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1488, Houston, TX 77030. E-mail: besmaeli@mdanderson.org

© 2019 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.