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

Publication date: Available online 9 January 2019

Source: Journal of the American Academy of Dermatology

Author(s): Chuandi Zhou, Fan Wu, Peiwei Chai, Yingyun Shi, Juan Ye, Xin Shi, Jia Tan, Yi Ding, Yingxiu Luo, Bita Esmaeli, Renbing Jia, Xianqun Fan

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 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 controlling all confounders.

Results

Among 360 patients included in this cohort, 115 (31.9%) of them underwent MMS as primary resection, whereas 245 (68.1%) cases underwent WLE. After a median follow-up period of 60.0 months, local recurrence was observed in 18 (15.7%) patients of the MMS group and 97 (39.6%) patients of the WLE group. Metastasis occurred in 9 (7.8%) patients who underwent MMS and 38 (15.5%) who underwent WLE. Six (5.2%) patients in the MMS group and 21 (8.6%) in the WLE group died of metastatic SC. Multivariable Cox regression indicated that, compared with the WLE group, the MMS group exhibited more favorable local recurrence control (HR=0.42; 95%CI:0.24-0.73; p=0.002), but a comparable metastasis rate (HR=1.38; 95%CI:0.60-3.18; p=0.453) and tumor-related mortality (HR=1.70; 95%CI:0.59-4.93; p=0.329). However, this beneficial effect became nonremarkable for patients with pagetoid intraepithelial neoplasia (HR=1.73; 95%CI:0.37-8.21; p=0.488).

Limitations

Retrospective nature.

Conclusion

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

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