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Journal of the American Academy of Dermatology
Volume 80, n° 6
page 1608 (juin 2019)
Doi : 10.1016/j.jaad.2018.12.053
accepted : 18 December 2018
Original Articles

Mohs micrographic surgery for eyelid sebaceous carcinoma: A multicenter cohort of 360 patients
 

Chuandi Zhou, MD, PhD a, b, Fan Wu, MD a, b, Peiwei Chai, MD, PhD a, b, Yingyun Shi, MD a, b, Juan Ye, MD, PhD c, Xin Shi, MD, PhD c, Jia Tan, MD, PhD d, Yi Ding, MD, PhD a, b, Yingxiu Luo, MD a, b, Bita Esmaeli, MD, PhD e, Renbing Jia, MD, PhD a, b, , Xianqun Fan, MD, PhD a, b,
a Department of Ophthalmology, Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China 
b Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China 
c Department of Ophthalmology, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China 
d Department of Ophthalmology, Xiangya Hospital, Central South University, Changsha, Hunan Province, China 
e Ophthalmic Plastic Surgery, Department of Plastic Surgery, The University of Texas M.D. Anderson Cancer Center, Houston, Texas 

Reprint requests: Xianqun Fan, MD, PhD, Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, No 639 Zhi Zao Ju Road, Shanghai 200011, China.Department of OphthalmologyNinth People's HospitalShanghai Jiao Tong University School of MedicineNo 639 Zhi Zao Ju RoadShanghai200011China∗∗Correspondence to: Renbing Jia MD, PhD, Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, No 639 Zhi Zao Ju Road, Shanghai 200011, China.Department of OphthalmologyNinth People's HospitalShanghai Jiao Tong University School of MedicineNo 639 Zhi Zao Ju RoadShanghai200011China
Abstract
Background

The decision to perform Mohs micrographic surgery (MMS) or wide local excision (WLE) for eyelid sebaceous carcinoma (SC) is controversial.

Objective

To compare local recurrence, metastasis, and tumor-related mortality of patients with eyelid SC who were initially treated with MMS versus with WLE.

Methods

A multicenter cohort study. Medical records were reviewed for factors associated with recurrence, metastasis, and tumor-related mortality. All eligible patients were followed up. The impact of initial surgical modality on the prognoses were determined by Cox analyses after control for all confounders.

Results

Of the 360 patients included in this cohort, 115 (31.9%) underwent MMS as primary resection, whereas 245 (68.1%) underwent WLE. After a median follow-up period of 60.0 months, local recurrence was observed in 18 patients (15.7%) in the MMS group and 97 patients (39.6%) in the WLE group. Metastasis occurred in 9 patients (7.8%) who underwent MMS and 38 (15.5%) who underwent WLE. In all, 6 patients in the MMS group (5.2%) and 21 in the WLE group (8.6%) died of metastatic SC. Multivariable Cox regression indicated that compared with the WLE group, the MMS group exhibited more favorable local recurrence control (hazard ratio [HR], 0.42; 95% confidence interval [CI], 0.24-0.73; P  = .002) but a comparable metastasis rate (HR, 1.38; 95% CI, 0.60-3.18; P  = .453) and comparable tumor-related mortality (HR, 1.70; 95% CI, 0.59-4.93; P  = .329). However, this beneficial effect became nonremarkable for patients with pagetoid intraepithelial neoplasia (HR, 1.73; 95% CI, 0.37-8.21; P  = .488).

Limitations

Retrospective nature of the study.

Conclusion

MMS should be proposed for eyelid SC without orbital involvement to achieve recurrence control; however, this surgical procedure did not change the long-term outcomes in terms of metastasis or tumor-related mortality. Patients with pagetoid intraepithelial neoplasia may require adjuvant measures.

The full text of this article is available in PDF format.

Key words : eyelid sebaceous carcinoma, metastasis, Mohs micrographic surgery, recurrence, tumor-related mortality

Abbreviations used : CI, HR, MMS, SC, UM, WLE



 Chuandi Zhou and Fan Wu contributed equally to this paper.
 Funding sources: Supported by the Scientific Research Program of the National Health and Family Planning Commission of China (201402014), The Science and Technology Commission of Shanghai (17DZ2260100), Innovation Fund for Translational Medicine (15ZH1005), and Shanghai Shuguang Project (14SG18). The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.
 Conflicts of interest: None disclosed.



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