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

Abstract

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.

Sebaceous Carcinoma of the Eyelid: A Case Report and Review of the Literature

“…Definitive Radiotherapy is used in non-surgical candidates or as an adjuvant for incompletely excised tumors or in case of perineural invasion and can be used palliatively for metastatic or incurable diseases [10].…”

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

“…Fortunately, a major improvement in examination and documentation of histopathological findings has taken place. Until recently, no treatment guidelines for SC were available in Finland or globally (Leivo et al 2020). Such guidelines including additional treatments have been recently written and will hopefully lead to better treatment standards (Esmaeli et al AJCC Cancer Staging Manual, 8th Ed 2017; Owen et al 2019).…”

S1‐Leitlinie Talgdrüsenkarzinom

“…9 Bei extensiver Beteiligung der Orbita oder angrenzender Strukturen sowie beim Versagen anderer Therapieoptionen kann allerdings eine Exenteration des Auges erforderlich werden. 9,65 In retrospektiven Studien wurde ein verlängertes krankheitsfreies Überleben durch eine Exenteration in einigen Fällen nachgewiesen. 66 Die Exenteration sollte dennoch nur solchen Fällen vorbehalten sein, bei denen andere Therapieverfahren nicht zum Erfolg geführt haben und eine extensive Beteiligung der Orbita oder periorbitaler Strukturen vorliegt.…”