Clinicopathological analysis of eyelid malignancies - A review of 85 cases

Clinicopathologic features and new factors affecting constitution of eyelid neoplasms: a 10-year multicentre experience in southern coastal China

OBJECTIVE

This study aims to delineate the key characteristics of eyelid neoplasms in central and southern coastal China and to explore potential factors affecting tumour development.

METHODS

This was a retrospective, multicentre observational study. In total, 1302 cases of eyelid neoplasms diagnosed in 2 tertiary hospitals were reviewed from January 2013 to May 2023. Histogenesis, pathologic diagnosis, and potential risk factors were investigated, and the findings were compared with data from various regions and countries. Age- and sex-specific incidence rates, time trends, distributions across age groups, and the relationship with the Sociodemographic Index, latitude, and altitude were calculated.

RESULTS

There were 1162 benign (89.2%) and 140 malignant (10.8%) cases, representing 63 pathologic types. The median age of benign cases (50 years) was significantly lower than that of malignant cases (72 years) (P < 0.05). The most common benign and malignant lesions were intradermal nevus (28.83%) and basal cell carcinoma (BCC) (74.29%). A relatively younger median age (68 years) for sebaceous gland carcinoma (SGC) was observed, with a male preponderance (sex ratio 2:1). Analyses of the proportions of BCC, SGC, and squamous cell carcinoma in eyelid malignancies revealed significant regression equations (P < 0.05).

CONCLUSIONS

Most eyelid neoplasms are of epithelial and melanocytic origin, with benign tumours being predominant. The regions with greater Sociodemographic Index exhibit a greater incidence of BCC and a lower incidence of squamous cell carcinoma and SGC. BCC appears to have a greater incidence in regions located at higher latitudes.

Complications and Recurrences after Excision and Reconstruction of Eyelid Tumours

INTRODUCTION

The eyelids are a common site for skin tumours and account for 5-10% of all skin tumours. Treatment is mainly surgical and aims to preserve the anatomical structure of the eyelid, its function and not least its aesthetic appearance.

AIM

Presentation of recurrence and complication rates of tumour-related eyelid surgery in a cohort of 450 tumours.

RESULTS

Analysis of a cohort of 450 tumours operated on revealed 13 (2.8%) operations with recurrences and 32 (7%) with complications. The statistical significance of recurrences was observed for the involved and uninvolved ciliary margin. At the temporal canthus, 23.1% of recurrences occurred compared to 7.7% at the medial canthus. SGC has the highest recurrence rate. Complications include the following: ectropion, dehiscence, gross cicatrix with normal function, retraction, post-radiation damage, sub-graft haemorrhage and graft rejection.

CONCLUSIONS

The recurrence rate of eyelid tumours is lower than that of complications. The choice of surgical technique determines the frequency of complications and histological control of the excised tissue, as well as the frequency of recurrences.

A comparison of novel silicone plate vs. auricular cartilage in upper eyelid reconstruction following excision of malignant tumor

Purpose: To compare surgical and functional outcomes, safety, efficacy and cost of silicone plate vs. autogenous auricular cartilage (AAC) as alternate material to tarsal plate for upper eyelid reconstruction after excision of malignant tumor. Methods: A prospective, comparative, interventional study of over 3 years was conducted on two groups of twenty patients each. All the patients had undergone the Modified Cutler Beard procedure with AAC being used as tarsal substitute in one group and a novel silicone plate in the other. Post-operative MRD 1, LPS action, Central Lid Thickness, and Lid contour were recorded at one week, one month and six months follow-up. Results: The pre-operative MRD 1 in the silicone plate and AAC group was -2.95 ± 1.19 mm and -3.05 ± 1(1).05 mm, post-operative in the silicone plate group 3.8 ± 0.4 mm, and in the AAC group, 3.8 ± 0.41 mm. The pre-operative LPS action in the silicone plate and AAC group was 1.2 ± 1.1 mm and 1.0 ± 0.9 mm and post-operative it was 13.8 ± 0.4 mm for the silicone plate group and 13.7 ± 0.4 mm for the AAC group. The post-operative lid thickness for the silicone plate group was 4.4 ± 0.17 mm and for the AAC group it was 4.4 ± 0.08 mm. Conclusion: The cosmetic outcome in terms of lid contour maintenance is better in the silicone plate group, in which it markedly reduces the surgical time, provides earlier rehabilitation, and eliminates disease transmission. Harvesting of AAC is a skillful and time-consuming procedure and adds to the post-operative morbidity due to the presence of a second surgical site. The low manufacturing cost of silicone plate as opposed to other allogenic and synthetic tarsal substitutes makes it readily available to resource limited populations. The silicone plate is reckoned to become the material of choice as tarsal substitute in the future. Abbreviations: AAC = Autogenous auricular cartilage, MRD-1 = Margin reflex distance-1, LPS = levator palpebrae superioris, PFH = palpebral fissure height.

Clinicopathological Analysis and Surgical Outcome of Eyelid Malignancies: A Study of 332 Cases

Background

Eyelid tumours are common in our ophthalmic practice. Malignancy cases account only for one-fourth of all eyelid tumours. The most aggressive eyelid malignancy is sebaceous gland carcinoma, but its occurrences are rare in western countries. We found sebaceous gland carcinoma is as common as basal cell carcinoma in our clinical practices. Hence, it is essential to build awareness about the more aggressive eyelid malignancies to reduce morbidity and mortality.

Aim

To assess the relative frequency of eyelid malignancies in the Bangladesh population, state their clinical features and outcome of management strategies and build awareness about the more aggressive eyelid malignancies to reduce morbidity and mortality.

Methods

This was a retrospective case series study of 332 patients in Bangladesh. This study analyzed all the recorded data of the histologically proven primary eyelid malignancies and followed them up for at least six months from 2014 to 2019 (6 years). All patients were managed by surgical excision with tumor-free margins verified on histopathology, either the frozen section or excision biopsy with 2–3 mm microscopic view of normal tissue followed by eyelid reconstruction. Computer-based statistical software SPSS was used for the analysis, and an appropriate test of significance (chi-square) was used for the statistical analysis.

Results

Sebaceous gland carcinoma (SGC) was the highest in occurrence, at 42%, followed by 38% basal cell carcinoma (BCC), 18% squamous cell carcinoma (SqCC), and 02% malignant melanoma (MM). The mean age at presentation of SGC, BCC, SqCC, and MM were 57.41 years, 62.56 years, 64.73 years, and 59.28 years, respectively. Female (59%) was slightly more preponderance over the male (41%) for SGC than other malignancies. Pigmentation was associated with malignant melanoma (100%) and BCC (81%). Statistically, a significant difference was found between eyelid malignancies, including location, size, pigmentation, recurrence, and invasiveness. The recurrence rate was low lower in the patients who underwent frozen section biopsy (3%) for margin clearance than those who underwent excision biopsy (21.5%) in the follow-up time. Conjunctival map biopsy (8%) was performed as an essential tool for excluding the pagetoid spread of SGC. A new reconstruction method named triangular-shaped musculocutaneous tail flap was performed in 33 (11%) patients to reconstruct the moderate eyelid defect following local resection.

Conclusion

Sebaceous gland carcinoma (SGC) was the highest occurrence found to be the highest occurrence among all eyelid malignancies in Bangladesh. SGC is more aggressive and the recurrence rate was higher than BCC and SqCC.

Eyelid Tumours in Northern Malaysia: A Five-Year Review

Background The majority of eyelid tumours are benign in nature and constitute 82%-98% of all eyelid tumours. This study aimed to explore the prevalence and frequency of histopathological diagnoses of eyelid tumours encountered in Hospital Sultanah Bahiyah (HSB), Malaysia, from 2016 to 2020. Method This study is a case series of 136 patients with eyelid tumours who underwent eyelid biopsy. Result Twenty-three (17%) patients were below 18 years old, 64 (47%) patients were between 19 and 64 years old and 49 (36%) patients were more than 65 years old. The mean age in this study was 47.9 ± 25.4 years. The most common benign eyelid tumours were dermoid cyst (31, 22.8%), melanocytic nevus (19, 14%), granuloma (17, 12.5%), squamous cell papilloma (13, 9.6%) and epidermal cyst (12, 8.8%). Most of the benign eyelid tumours occurred at the upper lids (79.8%), and most of the malignant eyelid tumours occurred at the lower lids (81.8%). The most common malignant eyelid tumours were basal cell carcinoma (BCC) (6, 14.3%), followed by malignant lymphoma (3, 6.1%) and sebaceous gland carcinoma (2, 4.1%). Eight out of nine cases of BCC were located at the lower lids. All malignant lymphomas were primary lymphoma. Five were extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT), and one was follicular lymphoma. All cases with benign and malignant tumours required only a single surgery for excision, and none of the cases had a recurrence. Conclusion There were limited references to the epidemiology of histopathological diagnoses of eyelid tumours in Malaysia. Although benign lesions comprise the majority of eyelid tumours, it is essential to delineate between benign and malignant eyelid tumours.

Malignant tumors of the eyelid in India: A multicenter, multizone study on clinicopathologic features and outcomes

Purpose:

To analyze data on eyelid malignancy in India, clinical and pathologic features, and outcomes.

Methods:

A multicentre study, from oculoplastic practices in four geographic zones in India. The centers perform similar documentation and protocol-based management for eyelid tumors. Clinical features, pathology, American Joint Committee on Cancer (AJCC) class, management, and the outcomes were analyzed.

Results:

The study included 129 patients, with slight female preponderance and mean age 62.7 years. The median delay to the consultation was 9 months. Rural patients traveled a mean distance of 115.2 km; there was no difference between the city and outstation patients in the delay to consultation or follow up. Pathology included 55/129 (42.6%) sebaceous gland carcinoma (SGC), 47/129 (36.4%) basal cell carcinoma (BCC), squamous cell carcinoma (SCC) in 15 (11.6%), and 12 (9.3%) other tumors. Commonest AJCC class was T2b/T3a in 80/111 (72%), invasion of the orbit was present in 16 (12.4%). Surgery with margin clearance was performed in 103. With a mean follow-up of 21.44 months, local recurrence and/or metastasis were seen in 12%. The diagnosis of SGC was strongly associated with adverse outcomes (odds ratio: 7.36). On multiple logistic regression analysis, diagnosis of SGC (P = 0.011) was significant in having adverse outcomes.

Conclusion:

The multicenter Indian data shows the highest prevalence of SGC, with the commonest AJCC class T2b. Most tumors were locally resectable at presentation. The histopathologic diagnosis of SGC is the factor strongly associated with adverse outcomes.

Sebaceous carcinoma of the eyelid: 21-year experience in a Nordic country

PURPOSE

To evaluate the clinical features, diagnostic challenges, management, and prognosis of sebaceous carcinoma (SC) of the eyelids and periocular region in a Nordic country.

METHODS

Patients were identified from the Finnish Cancer Registry and the Helsinki University Hospital databases during the 21-year period 1998-2018. Age, sex, location, clinical and histopathologic diagnosis, treatment and outcome were registered.

RESULTS

Sebaceous carcinoma (SC) was diagnosed in 32 patients. The incidence was 0.6 per million. Median age at the time of histopathologic diagnosis was 74 years, and 72% of patients were women. Diagnostic delay was often long, median 12 months. The most common cause for delay was misdiagnosis (72%): a chalazion in 34% and a benign tumour in 22%. The most common location was the upper eyelid (53%) and tumour type a solitary nodule (94%). The SC was not correctly diagnosed in 12 (40%) of 30 preoperative biopsies. The treatment for 31 (97%) patients was complete surgical removal with reconstruction. Conjunctival intraepithelial growth was found in 50%. The leading postoperative problem was ocular irritation (30%). During a median follow-up of 58 months, two patients (6%) experienced a local recurrence and one patient died from metastatic SC.

CONCLUSIONS

The estimated incidence of SC in Finland was somewhat higher than in other Western countries. The diagnosis was often markedly delayed. Especially differentiation from chalazion continues to be essential. To improve outcomes, it is essential to inform the pathologist about the possibility of SC in eyelid biopsies and specimens and ideally submit them to an ophthalmic pathology service.

Sebaceous Carcinoma of the Eyelid: A Systematic Review and Meta-Analysis

BACKGROUND

Sebaceous carcinoma (SC) of the eyelid is a rare, aggressive malignancy associated with high rates of recurrence, metastasis, and tumor-related mortality.

OBJECTIVE

Provide a collective analysis of clinical presentations, management techniques, and outcomes, and compare outcomes of common treatment methods.

METHODS AND MATERIALS

Observational studies reporting management and outcomes of SC of the eyelid were included. Patient and clinical data were extracted, and meta-analysis of proportions was performed.

RESULTS

One thousand three hundred thirty-three subjects were included with a mean age of 65.2 years and 803 (60.2%) women. Of 647 initial diagnoses reported, 277 (42.8%) were correct, and the mean diagnostic delay was 14.7 months (range 8.5-34.8). The tumor location was reported in 1,246 subjects and involved the upper eyelid in 780 (62.6%), lower eyelid in 409 (32.8%), and 57 (4.8%) involved both. Overall rates of recurrence, metastasis, and tumor-related mortality were 15.9%, 12.1%, and 6.2%, respectively. There were no statistically significant differences in wide local excision (WLE) versus Mohs micrographic surgery (MMS) outcomes.

CONCLUSION

Sebaceous carcinoma of the eyelid is more common in women, on the upper eyelid, and is frequently misdiagnosed initially. Rate of recurrence, metastasis, and tumor-related mortality were similar in subjects managed with WLE versus MMS.

Periocular Basal Cell Carcinoma: 20-Years Experience at a Tertiary Eye Care Center of South India

PURPOSE

To study the clinical profile and management outcomes of periocular basal cell carcinoma (BCC).

MATERIALS AND METHODS

A retrospective analysis of all histopathologically proven cases of BCC between 1995 and 2015 was done. The demographic data, clinical presentation, histopathological subtype, and management outcomes were analyzed.

RESULTS

We had a total of 185 malignant eyelid tumors during the study period, out of which 37 (20%) were BCC. Thirty-two (86.5%) out of 37 cases were primary BCC. The mean age was 63.3 years. Pigmented ulcerative lesion (14, 38%), lower eyelid (19, 51%), and nodular BCC (15, 40%) were the most common presentation, periocular site, and histological subtype, respectively. 28 patients underwent excision under frozen section with an average tumor-free margin of 3.5 mm. Mean follow-up period was 18.78 months. Recurrence rate of 0% and 3.1% was noted in primary and recurrent BCC, respectively.

CONCLUSION

Periocular BCC commonly presents as pigmented ulcerative lesion in the lower lid. Excision biopsy under frozen section with an average tumor-free margin of 3.5 mm offers cure in most cases.

Eyelid abscess masking underlying sebaceous cell carcinoma

Sebaceous cell carcinoma is well known as the "great masquerader" mimicking other benign or malignant eyelid conditions and lesions. We present a case of a middle age male presenting with a subacute left upper lid abscess who was ultimately diagnosed with malignant sebaceous cell carcinoma after incision and drainage and treatment with broad spectrum antibiotics. This case highlights the deceptive clinical and radiographic appearance of this tumor and the importance of histologic examination in atypical or refractory periorbital abscesses.

Clinicopathologic Characteristics and Predictors Affecting Survival Outcome of Eyelid Malignancy

The aim of this study was to determine the clinicopathologic characteristics and evaluate the prognostic factors in eyelid malignancies. This was a retrospective, comparative, case series of 70 patients with eyelid malignancies. The mean age at diagnosis was 72.0 years (range 30.5-93.0 years) with 64.3% female. The 2 most common histologic types were basal cell carcinoma (BCC) followed by sebaceous gland carcinoma (SGC). In total, 47.1% of the malignancies were located in the lower eyelid and the majority of tumor (T) category was T1. The authors assessed the disease-specific survival rates of 64 surgical patients using Kaplan Meier curves. Univariate and multivariate analyses identified the predictors associated with disease-specific survival. Of the 64 surgical patients, 4 had regional nodal metastasis (2 SGC, 1 squamous cell carcinoma [SCC], and 1 adenocarcinoma) and distant metastasis at diagnosis was in 3 patients (2 SGC and 1 malignant melanoma [MM]). Six patients died of disease during follow-up. The 5-year disease-specific survival in BCC, SCC, and SGC were 100%, 100%, and 64.8%, respectively. The predictive factors affecting worse disease-specific survival on multivariate models were T4 category (adjusted hazard ratio [aHR] 14.15, P = 0.022) and tumor recurrence (aHR 6.84, P = 0.045). In conclusion, BCC was the most common eyelid malignancy in southern Thailand followed by SGC. In this study, T4 category and tumor recurrence were the most important prognostic factors in eyelid malignancies.

Vimentin overexpression as a novel poor prognostic biomarker in eyelid sebaceous gland carcinoma

BACKGROUND

Vimentin is an intermediate-sized filament which is highly expressed in mesenchymal cells and is associated with epithelial-mesenchymal transition (EMT). EMT markers ZEB2 and Slug lead to Vimentin overexpression and E-cadherin loss, resulting in invasion and metastasis. However, the status of Vimentin remains unexplored in eyelid sebaceous gland carcinoma (SGC). The study aims to determine status of Vimentin in SGC and its association with EMT markers E-cadherin, ZEB2 and Slug.

METHODS

Vimentin protein expression was undertaken in 66 cases with SGC by immunohistochemistry (IHC). Messenger RNA (mRNA) expression was determined in 42 fresh tissues by quantitative real-time PCR. Association of Vimentin with E-cadherin, ZEB2 and Slug was also analysed. Patients were followed up for 17-69 months (mean 34.02 ± 14.73 months).

RESULTS

IHC revealed Vimentin overexpression in 37/66 (56%) cases. This overexpression showed significant association with lymph node metastasis (p=0.004) and pagetoid spread (p=0.05). Patients with high Vimentin expression also had poor disease-free survival (p=0.033). Univariate Cox regression model indicated that high Vimentin expression (p=0.043) and advanced tumour stage (p=0.002) were independent adverse prognostic factors. High Vimentin mRNA expression was seen in 16/42 (38%) cases and correlated significantly with lymph node metastasis (p=0.027), advanced tumour stage (p=0.002) and large tumour size (p=0.023). Vimentin expression overall showed a significant inverse association with E-cadherin and direct association with ZEB2 expression.

CONCLUSIONS

Vimentin overexpression in SGC is associated with EMT and leads to poor clinical outcome. It also emerged as a novel predictor for lymph node metastasis and poor survival.

A retrospective study of 2228 cases with eyelid tumors

AIM

To describe the histopathologic and clinical features of eyelid tumor cases from Tianjin Eye Hospital during 2002 to 2015.

METHODS

In this retrospective study, a total of 2228 cases of eyelid tumors with pathologic diagnoses were enrolled. The eyelid tumors were classified into three groups according to tumor origin: epidermal, adnexal and miscellaneous, including melanocytic, neural and vascular lesions. Inflammatory tumor-like lesions were excluded. The clinical characteristics of the eyelid tumors were analyzed, including age, gender and lesion location.

RESULTS

Most eyelid tumors were epidermal in origin (1080, 48.5%), followed by miscellaneous (885, 39.7%) and adnexal tumors (263, 11.8%). Among all the tumors, 292 (13.1%) were malignant lesions, 1910 (85.7%) benign and 26 (1.1%) premalignant lesions. Most malignant tumors originated from epidermal cells (60.0%), followed by adnexal cells (34.6%). The most common malignant tumors were basal cell carcinomas (56.5%) followed by sebaceous carcinoma (34.6%), squamous cell carcinomas (3.8%) and lymphoma/plasmocytoma (1.7%). The benign and premalignant eyelid lesions mostly originated from epidermal cells (46.4%) followed by miscellaneous cell sources (45.2%), including melanocytic nevus (33.8%), seborrheic keratosis (13.7%), squamous cell papilloma (13.0%) and epidermal cysts (11.5%).

CONCLUSION

Eyelid tumors are mostly epithelial in origin. Benign tumors are significantly more common than malignant tumors with an obvious female predominance, and the most frequent malignant tumor are basal cell carcinoma, sebaceous carcinoma and squamous cell carcinomas. The tumor clinical features varied among the different subtypes.

Malignant Eyelid Tumors in India: A Study of 536 Asian Indian Patients

Purpose

To study the proportion of eyelid malignant tumors in an Asian Indian population and to review their clinical features and outcomes.

Methods

This is a retrospective study of 536 patients.

Results

The mean age at presentation with eyelid malignancy was 58 years. Histopathology-proven diagnoses of these patients included sebaceous gland carcinoma (SGC) (n = 285, 53%), basal cell carcinoma (BCC) (n = 128, 24%), squamous cell carcinoma (SCC) (n = 99, 18%), and miscellaneous tumors (n = 24, 4%). The statistically significant differences between eyelid malignant tumors included age at presentation, tumor location, and tumor extent. The clinicopathological correlation of SGC, BCC, SCC, and miscellaneous tumors was 91, 86, 46, and 38% (p = 0.001), respectively. Comparing SGC with BCC, SCC, and miscellaneous tumors, SGC was more commonly associated with tumor recurrence (21 vs. 3, 8, and 13%; p = 0.001), systemic metastasis (13 vs. 0, 4, and 13%; p = 0.001), and death (9 vs. 0, 4, and 0%; p = 0.004). Compared to SGC, BCC, and SCC, locoregional lymph node metastasis was more common with miscellaneous tumors (26 vs. 16, < 1, and 8%; p = 0.001) over a mean follow-up period of 19 months.

Conclusion

In Asian Indians, SGC is twice as common as BCC and 3 times more common than SCC. SGC is associated with poorer prognosis compared to other eyelid malignant tumors.

Intraoperative Adjunctive Mitomycin C and Cryotherapy for Recurrent Conjunctival Papillary Sebaceous Carcinoma

Purpose

To report a case of recurrent conjunctival papillary sebaceous carcinoma that was successfully treated by a combination of surgical resection, intraoperative topical mitomycin C application, and cryotherapy.

Observations

A woman in her 80s developed a yellowish papillary tumor pedunculated from the surface of the upper palpebral tarsal conjunctiva in her left eye. She was histopathologically diagnosed as having sebaceous carcinoma by an excisional biopsy. We performed en bloc resection of the lateral one-third of the posterior lamella including the cutaneous margin of the upper eyelid as well as reconstruction of the defected portion by a switch-flap from the ipsilateral lower eyelid. Histopathologically, because the tumor was restricted to the epithelial region with minimal invasion into the tarsus, we diagnosed the patient to have conjunctival papillary sebaceous carcinoma. Nine months after the surgery, the tumor recurred and was resected and treated by intraoperative mitomycin C. Four months later, the tumor regrew at the resected margins and was treated by resection combined with mitomycin C and cryotherapy. After these combination treatments, the tumor did not recur for at least 1 year postoperatively.

Conclusion and Importance

Although sebaceous carcinoma usually originates from the meibomian gland cells or less frequently from the Zeis or Moll gland cells, it rarely occurs from bulbar or palpebral conjunctival cells. Because sebaceous carcinoma sometimes shows a pagetoid growth pattern, it can recur even after en bloc resection with a negative study for tumor cells at the surgical margins. The recurrent sebaceous carcinoma cells showed an intraepithelial growth pattern. Considering this superficial growth property, it may be effective to apply intraoperative mitomycin C and cryotherapy treatment combined with surgical resection to reduce the possibility of recurrence of presumed conjunctival papillary sebaceous carcinoma, although mitomycin C alone seems to be insufficient as an adjunctive treatment.

14-year case series of eyelid sebaceous gland carcinoma in Chinese patients and review of management

Aims

Sebaceous gland carcinoma (SGC) of the eyelid is a rare but potentially deadly cancer. The purpose of this study was to determine whether the American Joint Committee on Cancer (AJCC) 7th Edition T category for SGC correlated with metastasis and survival in the Chinese population.

Methods

This was a retrospective, single-centre cohort study. Patients with surgically resected eyelid SGC between January 2001 and May 2015 at the Hong Kong Eye Hospital were reviewed. Tumours were staged using the AJCC criteria. The main outcome measures included local recurrence, metastasis and death. Disease-free survival (DFS) was measured from the completion of treatment; overall survival was measured from the date of initial diagnosis.

Results

The study included 22 Chinese patients with a mean age of 65.4 years. The majority presented as a nodular lesion (91%) with 12 eyes (54.5%) initially misdiagnosed and a mean presentation time of 1 year. It was found that those with AJCC stage T2b or higher were significantly associated with lymph node metastasis (P=0.002) when compared with those with stage T2a. Older age at diagnosis (P=0.035) and no misdiagnosis (P=0.025) were associated with shorter DFS. Those with stage 3a or higher were associated with shorter DFS (P=0.007) and overall survival (P=0.024).

Conclusion

Similar to previous reports, in this Chinese cohort, AJCC staging for SGC correlated with lymph node metastasis, DFS and overall survival. Those with stage 2b or higher on presentation will need closer surveillance for lymph node metastasis and may benefit from sentinel lymph node biopsy.

Primary Orbital Melanoma: Presentation, Treatment, and Long-term Outcomes for 13 Patients

BACKGROUND

Periocular melanoma is a rare but often deadly malignancy that arises in the uvea (commonest origin), conjunctiva or orbit (rarest primary site). Melanoma accounts for 5-10% of metastatic/secondary orbital malignancies, but only a tiny proportion of primary orbital neoplasia. Primary orbital melanoma (POM) is exceedingly rare, with approximately 50 cases reported to date.

METHODS

All patients seen in the orbital unit at a tertiary referral hospital (1991-2016) with a biopsy-proven diagnosis of POM were identified from a diagnostic database and were studied. The case notes, imaging, surgical approach, and histology were reviewed.

RESULTS

Thirteen patients (five male; 38%) presented with isolated malignant melanoma of the orbit, for which no other primary site was identified at presentation or during an average follow-up of 44 months (median 22; range 0-13 years). The patients presented between the ages of 40 and 84 years (mean 55.5; median 48 years) and typically gave a short history of rapidly increasing proptosis and eyelid swelling. On the basis of history, a malignant lesion was suspected in most patients and all underwent incisional biopsy, with debulking of the mass in 10 (77%) patients, and skin-sparing exenteration in 3/13 (23%). Ten patients underwent orbital radiotherapy and the survival to date ranged from 9 months to 14 years (mean 55 months; median 23 months); two patients received solely palliative care for widespread disease and one patient refused orbital radiotherapy. Five of the 13 (38%) patients died from the disease.

DISCUSSION

POM is a very rare malignancy, but clinical analysis of this cohort gives insight into disease presentation and prognosis. The tumor typically presents with a rapidly progressive, well-defined mass that is, in some cases, amenable to macroscopically intact excision. Unusual for malignant melanoma, some of these patients can show an unusually long period of quiescent disease after surgical debulking and radiotherapy.

Morphological Spectrum of Basal Cell Carcinoma in Southern Karnataka

INTRODUCTION

Basal Cell Carcinoma (BCC) is the most common skin cancer worldwide, which appears over sun-exposed skin as slow-growing, locally invasive lesion that rarely metastasizes. Many phenotypic presentations are possible. BCCs are more common in males and tend to occur in older people. Majority is found on the head and neck. Many histopathological subtypes have been defined including nodular, micronodular, cystic, superficial, pigmented, adenoid, infiltrating, sclerosing, keratotic, infundibulocystic, metatypical, basosquamous and fibroepitheliomatous. Mixed patterns are common.

AIM

The aim was to study morphological spectrum of BCC in a tertiary care hospital in southern Karnataka.

MATERIALS AND METHODS

This was a retrospective analysis of 100 cases of BCCs reported in the Department of Pathology over a 9-year period from 2006 to 2014.

RESULTS

The mean age of presentation was 62 years. There was slight female preponderance (56%). The most common location was face (65%) and the most common presentation was ulceration (45%). Of the 100 BCCs, 50% were nodular, 13% infiltrating, 6% basosquamous, 4% superficial, 3% keratotic, 3% multinodular and 1% mixed.

CONCLUSION

BCC, besides being the commonest cutaneous cancer, is also known for its numerous histological patterns which are shown to have prognostic implications. This study reveals the frequency of the various histological patterns of BCC in southern Karnataka, where it has been rarely studied before.

Retrospective clinicopathological study of 129 cancerous and 18 precancerous lesions of the eyelids in North-Western Greece

This study aimed to present precancerous and cancerous epithelial eyelid lesions, their histopathological features, and possible correlations with clinical parameters. The retrospective study included 147 formalin-fixed, paraffin-embedded samples. We studied precancerous and cancerous epithelial eyelid lesions. Preneoplastic tumors were represented by 12 actinic keratoses and 6 in situ squamous cell carcinomas (Bowen disease) and skin epithelial tumors by 119 basal and 10 squamous cell carcinomas. We recorded the clinicomorphological and histopathological features of the specimens and investigated possible correlations. In our study, the vast majority of pre-malignant and malignant tumors occurred in advanced age (mean age of occurrence: 70.18 years). The data analysis showed that inflammation in patients with basal cell carcinoma (BCC) positively correlated with advanced age (p < 0.01), tumor diameter (p < 0.05), and the appearance of ulceration (p < 0.001). A prevalence of female sex was noted in the BCC group. We also found that inflammation with or without the presence of ulceration was more commonly seen in carcinomatous lesions than in preneoplastic lesions (p < 0.05). Inflammation occurrence is present in high proportions in the tumors studied and correlates with some clinicopathological parameters such as the age of patients, the mean tumor diameter, and the presence of ulceration. The comparison between premalignant and malignant conditions showed that inflammation probability increases as we move toward the more aggressive tumor phenotypes.

Periocular sebaceous gland carcinoma: A comprehensive review

Sebaceous gland carcinoma (SGC) is a rare tumour occurring at periocular and extra-ocular sites. SGC can be a challenging diagnosis for both clinicians and pathologists. High recurrence rates and a tendency for intra-epithelial spread, locoregional and distant metastases make it important for SGC to be suspected and be included in the differential diagnosis of an eyelid lesion. Early diagnosis, that may sometimes need ancillary testing, and prompt management using a multimodal approach can help reduce morbidity and mortality in patients with SGC.

Clinicopathologic features and prognostic factors of malignant eyelid tumors

AIM

To investigate the clinical characteristics and prognosis of patients with malignant eyelid tumors.

METHODS

This was a retrospective, non-randomized, clinical reviews. Between January, 2002 and December, 2011, 75 cases with histologically confirmed malignant eyelid tumors were evaluated. Patients' charts were reviewed for clinical information, treatment procedure, and disease course. Survival analysis in terms of recurrence-free survival was performed using age, sex, location of tumor and histopathological type. The follow-up ranged from 1 to 78 months (mean=21 months).

RESULTS

The 75 eyelid tumors included 35 basal cell carcinoma (BCC, 46.7%), 22 sebaceous gland carcinoma (SGC, 29.3%), 7 squamous cell carcinoma (SCC, 9.3%), 10 malignant melanoma (MM, 13.3%), and 1 Merkel cell carcinoma (MCC, 1.3%). Recurrence developed in 17 cases (22.7%). The recurrence rate of BCC (4/35, 11.4%) was significant lower than MM (6/10, 60.0%, P<0.001). The mean interval of recurrence was 21 months (range 3-62) for all eyelid tumors. Tumor located at canthus had higher recurrence rate (50%) compared with those located at eyelid (19%, P<0.05). Histological type was independent variable for recurrence by Cox regression analysis.

CONCLUSION

It is important to achieve a negative tumor margin in canthus located malignant eyelid tumor. Clinicians should have a high level of suspicion for recurrence according to histological type when treating patients with eyelid tumor.