Eyelid sebaceous gland carcinoma (SGC) treated with ‘slow’ Mohs' micrographic surgery

Arora, Anita; Barlow, R.J.; Williamson, John; Olver, Jane

doi:10.1038/sj.eye.6701330

Cited by 19 publications

(4 citation statements)

References 10 publications

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“…109,119 SGC risk factors that have been associated with a poor prognosis include vascular, lymphatic, and orbital invasion; poor tumor differentiation; infiltrative pattern; involvement of both upper and lower eyelids; multicentric tumor distribution; pagetoid spread; lacrimal or conjunctival primary; duration longer than 6 months; and tumor diameter >10 mm. 109,127,128 Given the tendency of SGC to exhibit multicentricity, pagetoid spread, and noncontiguous growth, the determination of negative margins in SGC of the eyelid using MMS and other surgical techniques may be difficult. [120][121][122][123][124][125][126] Other treatment options include the "slow" Mohs technique, MMS using paraffin-embedded sections and frozen-section margin control.…”

Section: Sebaceous Gland Carcinomamentioning

confidence: 99%

“…[120][121][122][123][124][125][126] Other treatment options include the "slow" Mohs technique, MMS using paraffin-embedded sections and frozen-section margin control. 109,127,128 Given the tendency of SGC to exhibit multicentricity, pagetoid spread, and noncontiguous growth, the determination of negative margins in SGC of the eyelid using MMS and other surgical techniques may be difficult. 88,109,125 Multiple "mapping biopsies" may be used to ensure accurate tumor margins, especially with conjunctival involvement.…”

Section: Sebaceous Gland Carcinomamentioning

confidence: 99%

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Periocular Cutaneous Malignancies: A Review of the Literature

Slutsky

Jones

2012

Dermatologic Surgery

105

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Timely diagnosis and management of periocular malignancies is essential because of their proximity to and potential to invade vital structures such as the orbit, sinuses, and brain. Surgical excision remains the standard of care for the majority of periorbital malignancies, but given the sensitive anatomic location, tissue-sparing techniques with margin control such as Mohs micrographic surgery are the preferred method for most nonmelanoma skin cancers. Depending on tumor type, other treatment modalities may include radiation, chemotherapy, cryosurgery, topical medications, and photodynamic therapy.

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Section: Sebaceous Gland Carcinomamentioning

confidence: 99%

Section: Sebaceous Gland Carcinomamentioning

confidence: 99%

Periocular Cutaneous Malignancies: A Review of the Literature

Slutsky

Jones

2012

Dermatologic Surgery

105

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“…It is not exactly Mohs' or ''slow Mohs'' as the histopathologist and the surgeon are different individuals. The marginal strip technique is similar to slow Mohs' 16 and is specific for lid-margin lesions with the advantage of having a continuous margin of tissue in which any spread of tumour can be located. We recommend the use of the technique in lid margin where tarsus is present throughout the specimen and .4 mm from the lid margin.…”

Section: Discussionmentioning

confidence: 99%

Confident complete excision of lid-margin BCCs using a marginal strip: an alternative to Mohs' surgery

Dhingra

Gajdasty

Neal

et al. 2007

British Journal of Ophthalmology

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Aims: To report a new technique of tissue preparation, using a marginal strip, after the excision of eyelid basal cell carcinomas (BCCs) and to report the long-term results of BCCs excised using this technique. Method: After the excision of eyelid BCC with a safety margin of 4 mm, a 1 mm strip was excised along the whole perimeter from the margin of the freshly excised specimen. This marginal strip had intact conjunctival mucosa along one edge and skin along the other. The marginal strip and the central tumour mass were then fixed immediately in formal saline and subjected to conventional histopathology. Results: Of the 61 patients who completed a 5 years follow-up, the results of 28 eye-lid BCCs that were within 4 mm of the lid margin are reported. The marginal strip was clear in 22 specimens and had the presence of residual tumour in its margin in 6 specimens. These six 6 cases were further managed by observation (n = 2), by further surgical excision using marginal strip (n = 2) and by Mohs' surgery (n = 2). Conclusion: Marginal strip examines the entire resection margins analogous to Mohs' technique and we recommend its use in lid margin where tarsus is present throughout the specimen and .4 mm from the lid margin. It is an indolent and slowly progressive tumour that is locally invasive and rarely metastasizing. Various treatments described in the literature include surgery, radiotherapy, cryotherapy, laser ablation, photodynamic therapy, chemotherapy and immunotherapy. 2 Surgical excision is the preferred method for removal of tumour as it is the only technique in which the margins can be examined. Previously published studies have shown that residual tumours are found in the margins of excised specimen in about 50% of surgical BCC excisions. 3 The introduction of microscopically controlled tumour excision by Mohs 4 in 1941 and its further refinement has led to considerable improvements in surgical tumour excision. Mohs micrographic surgery (MMS) provides a combination of high cure rate and tissue conservation, and is therefore widely used for treating morpheaform tumours and the tumours on the head and neck. The literature suggests an overall 5-year cure rate of 99-100% after MMS for primary BCC and 94% for recurrent BCC. However, Mohs' surgery is time consuming, personnel intensive, expensive and is not readily available.The aims of this study are to report a new technique of tissue preparation prior to histopathology and to report long-term (.5 years) results of BCCs excised using a marginal strip. MATERIAL AND METHODSPatients presenting with clinically diagnosed BCC to the oculoplastic services at Cardiff Eye Unit, Cardiff, UK, between 1995 and 2000, were included in the study. After obtaining informed consent, all the lesions were excised under local anaesthesia using lignocaine 2% with adrenalin 1:200 000. The surgical technique and the histological preparation of the excised specimen are described below. TechniqueThe tumour margins were determined and marked out by observing the transition in surface...

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“…Good results have also been published using frozen sections and therefore many authors prefer it [6,8,13,20,32,33]. Some prefer multi-stage resection with permanent margins and delayed closure, reporting 12% recurrence rates [7,34,35]. Multicentricity of sebaceous carcinoma makes the securing of clear margins difficult with all methods.…”

Section: Treatmentmentioning

confidence: 99%

Nordic treatment practices survey and consensus for treatment of eyelid sebaceous carcinoma

et al. 2020

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Background: The purpose was to describe the Nordic treatment practices and to reach a Nordic consensus for the treatment of sebaceous eyelid carcinoma. Methods: The treatment practices data was collected by a questionnaire with 37 questions to the Nordic oculoplastic surgeons and analyzed. A PubMed MEDLINE database search was done to gather data on the published treatment practices and recommendations. A working group that consisted of in minimum one senior consultant from each leading Nordic University Eye Hospital was assigned. A structured interactive method was used to establish the consensus. Results: Twenty-four doctors responded to the questionnaire. 23/24 (96%) of the respondents took a biopsy before surgery. Regional lymph node scanning was routinely done by 14/23 (61%) and a systemic screening of a metastatic disease by 13/23 (57%). 6/22 (27%) never took conjunctival mapping biopsies and 12/23 (52%) never screened for Muir-Torre. Respondents used Mohs surgery, frozen section or multi-stage excision with delayed closure, and 5-6 mm was the mostly preferred margin. Sentinel lymph node biopsy was a possible option for 9/22 (41%) and cryotherapy and Mitomycin C for 6/22 (27%) respondents. 50% of respondents considered radiation as a treatment option. 15/16 (94%) respondents always followed-up their patients, most for 5 years. Two thirds scanned regional lymph nodes during the follow-up. Consensus was reached for 18 statements representing three domains: preoperative work-up, treatment and follow-up. Conclusion: Treatment practices differ in between the five Nordic countries which have similar public health care systems. In the article the authors present a Nordic consensus for the treatment of eyelid sebaceous carcinoma.

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Eyelid sebaceous gland carcinoma (SGC) treated with ‘slow’ Mohs' micrographic surgery

Cited by 19 publications

References 10 publications

Periocular Cutaneous Malignancies: A Review of the Literature

Periocular Cutaneous Malignancies: A Review of the Literature

Confident complete excision of lid-margin BCCs using a marginal strip: an alternative to Mohs' surgery

Nordic treatment practices survey and consensus for treatment of eyelid sebaceous carcinoma

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