Clinicopathological analysis of eyelid malignancies - A review of 85 cases

Abstract

Background:Resection of eyelid malignancies leads to complex reconstructive problems due to the functional and aesthetic importance of an eyelid. Hence, a large number of such cases are referred to plastic surgery facilities. Eyelid malignancies are of varied histological types and the western and Asian data have considerable variations in case distribution and presentation. This study is an attempt to characterise these tumours in the Indian population.Materials and Methods:The present study is a retrospective analysis of 85 consecutive cases of eyelid malignancies that reported to a tertiary health care facility in central India over a 15-year period starting from January 1996 up to December 2009. The cases were analysed for their age of presentation, sex distribution, tumour location, delay in seeking treatment, recurrence rate and variations with respect to the pathological subtype.Observations:Mean age of presentation for all the malignancies was 59 years. The median age of presentation was 65 years for basal call carcinoma (BCC), 58 years for sebaceous gland carcinoma (SGC), 55 years for squamous cell carcinoma (SCC) and 45 years for malignant melanoma. There was slight female preponderance as 56.28% of the patients were females. The most common location of the tumour was lower lid (58.2%) for all the malignancies. BCC was the most common malignancy (48.2%) followed by SGC (31.2%) and SCC (13.7%). Mean duration of symptoms was 9 months (range 3-21 months). The most common presenting complaint was mass with ulceration across all histological subtypes. Other associated complaints included itching, discharge from eye, pain and ptosis. The mean size of tumour at diagnosis was 2.34 ± 0.4 cm for BCC, 2.19 ± 0.6 cm for SGC and 1.99 ± 0.7 cm for SCC. The mean rate of growth of BCC was 1.39 cm/year. The corresponding values for SGC and SCC were 3.63 and 4.89 cm/year, respectively. The rate of follow-up was 89% at 3 months, 71% at 6 months, 62% at 1 year and 31% at 5 years. Recurrence rate was 1.9% for BCC and 12.7% for SGC. Surgical methods used included wedge excision and primary closure, excision and skin grafting, and tarso-conjunctival flap.Conclusions:We recommend that the surgeons treating eyelid malignancies in India should have a high index of suspicion for SGC. A wider margin of 10 mm is recommended for SGC excision as opposed to 5 mm for BCC.

Histomorphological spectrum of eyelid lesions–A 6 year retrospective study

“…In Western countries, Basal cell carcinoma is the commonest malignant eyelid tumour accounting for 80-90 % of eyelid cancers followed by Squamous cell carcinoma and Sebaceous gland carcinoma[1,7].Increased incidence of Sebaceous gland carcinoma and reduced Basal cell carcinoma might be attributed to oily skin and more melanin pigment in Indian population. At the same time, a decline in basal cell carcinoma and squamous cell carcinoma can be due to increased melanin which provides protection from damaging sunrays.Sebaceous gland carcinoma was more common in females and upper eyelid in the present study and same results were shown in studies bySushma TA et al, Mary HO et al, Kale SM et al, Kaliki S et al and Wang JC et al, justifying the fact that Sebaceous glands are more in upper eyelids than lower eyelids[1,14,20,24,23]. Lin et al described a significantly higher incidence of Sebaceous gland carcinoma in Taiwan…”

Profile of Eyelid Tumors at Tertiary Care Institute in Karnataka: A 5-Years Survey

“…The most common location of all malignant tumors in this study was the lower eyelid (74%), which has been reported in previous studies. [2,12,19,24] Patients with SGC showed very strong preference for upper eyelid (83.3%).The lower eye lid was also the most common site for all histological subtypes except SGC.…”

“…[1] Studies by Paul S et al, Cook BE Jr et al, Deprez et al reported 71.8%, 90.8% and 86% BCC respectively, which was the most common malignant tumor in their case series. [3][4][5] However reports from central India(Sihota et al (30%), Jahagirdar S S et al (44.5%), Kale SM et al (48.2%) [17,18,19] show a relatively lower incidence of BCC. In our cases series BCC accounted for 26.3% and was the 2 nd most common malignant tumor.…”

“…[22,23,29] In the white population SGC is rare, accounting for 1-5.5% of all eyelid malignancies. [12,19,22,29] Racial and genetic predisposition may probably play an important etiological role. [24] SGC is known to masquerade as chalazion in eyelid, hence the possibility of SGC should be considered in Asians presenting with persistent or recurrent chalazion.…”

“…[29] Thailand, India, Japan, China studies provide evidence, in favour of a higher proportion (30-40%) of occurrence of SGC. [13,17,18,19,23,24] Chinese studies have reported an incidence of 8-29% [22,24,30] An incidence of 10% has been reported from Singapore accounting for less incidence of SGC. [25] In studies by Ni et al (U S) observed that SGC accounted for 32.7% of malignant eyelid tumors in Shanghai; whereas, at the Massachusetts Eye and Ear Institute in United states, SGC accounted for only 1.5% of malignant eyelid tumors.…”