Prognostic factors for relapse and survival among patients with ocular adnexal lymphoma: validation of the eighth edition of the American Joint Committee on Cancer (AJCC) TNM classification.

BACKGROUND/AIMS: To validate the prognostic performance of the American Joint Committee on Cancer (AJCC) eighth edition classification for ocular adnexal lymphoma (OAL). METHODS: We performed a retrospective review of 140 consecutive patients treated for primary OAL between March 2010 and September 2017. Associations between T/N/M categories at presentation and disease-related outcomes, including relapse, progression-free survival (PFS) and overall survival (OS) were evaluated. RESULTS: Seventy-nine women and 61 men (median age, 52 (range 20-84) years; median follow-up, 57 (range 7-131) months) were included. Histological subtypes included mucosa-associated lymphoid tissue lymphoma (92.1%, n=129), diffuse large B-cell lymphoma (5.0%, n=7), follicular lymphoma (1.4%, n=2) and mantle cell lymphoma (1.4%, n=2). Patients with ≥T2 disease had significantly higher risks of overall relapse (unadjusted HR)=4.32, p=0.016), decreased PFS (uHR=5.19, p=0.004) and decreased OS (uHR=9.21, p=0.047). Patients with ≥N1 disease had significantly higher risks of overall relapse (uHR=9.17, p<0.001) and decreased PFS (uHR=9.24, p<0.001). M1 disease was significantly associated with higher risks of overall relapse (uHR=3.62, p=0.036), decreased PFS (uHR=5.13, p=0.001) and decreased OS (uHR=9.24, p=0.013). On considering TNM categories as continuous data, the uHRs for per level increase in T, N and M categories were 1.77, 1.83 and 2.30 for overall relapse and 1.72, 1.87 and 2.78 for decreased PFS, respectively (p<0.05 for each comparison). CONCLUSION: The T, N and M categories of the AJCC eighth edition classification have prognostic value for relapse and survival among patients with primary OAL. Particularly, nodal/metastatic involvement at presentation indicated less favourable outcome.

Periocular intraepithelial sebaceous neoplasia: critical appraisal of nomenclature and prognostic importance.

Intraepithelial sebaceous neoplasia in the forms (or subclassification) of pagetoid spread and carcinoma in situ is a common feature of periocular sebaceous carcinoma and is associated with less favourable outcomes. Seminal studies of periocular sebaceous carcinoma in the 1980s indicated that the two patterns of intraepithelial spread had differing influences on prognosis with pagetoid invasion being worse. Later studies reported conflicting results, but careful inspection of those studies revealed considerable variation in what was meant by pagetoid invasion. Different interpretations of pagetoid spread continue, leading to ambiguous results in clinical studies and miscommunication with potential unintended decisions affecting clinical management. This paper reviews the background leading to the frequent interchangeable use of pagetoid spread with in situ sebaceous carcinoma and how this problem confounds interpretation of clinical studies. The author recommends that for effective communication, all morphological patterns of in situ spread of sebaceous carcinoma fall under the term intraepithelial sebaceous neoplasia, which can be accompanied by subclassification whenever desired.

Comparative study between conventional camera images and smartphone images for eyelid tumor telediagnosis. / Estudo comparativo entre imagens de câmera fotográfica convencional e smartphone para o telediagnóstico de tumores palpebrais.

OBJECTIVE: to compare the accuracy of eyelid tumor diagnosis obtained by evaluating conventional camera images with the ones obtained by evaluating smartphone images. METHODS: from January 2016 to July 2017, 36 patients underwent face-to-face external assessments and biomicroscopic examinations to establish clinical diagnoses. The lesions were photographed using Canon PowerShot SX530 HS Digital Camera (16.8 Megapixels) and Samsung GALAXY S4 smartphone camera. All lesions were resected and submitted to anatomopathological examinations. Preoperative images were sent to two specialists in eyelid diseases and then remotely analyzed. Data from in-person diagnoses and telediagnoses were compared with the gold standard of histological diagnosis. RESULTS: the most frequent lesions were basal cell carcinoma (33.3%), actinic keratosis (19.4%), and nevus (13.9%). Kappa coefficient for the diagnosis of malignant lesion showed agreement between the two tele-evaluators in the conventional digital camera images (0.68) and in the smartphone images (0.78). The face-to-face examiner's accuracy was of 94.4%; the tele-evaluators' accuracy in the conventional digital camera images was of 83.3% and in the smartphone images varied from 80.6% to 86.1%. Comparing the in-person diagnoses with the telediagnoses (obtained by evaluating conventional digital camera images or smartphone images), there was no significant difference in the hit rates. CONCLUSION: for eyelid tumor telediagnosis, images obtained using smartphone camera were equivalent to those obtained using conventional digital camera.

OBJETIVO: comparar a acurácia do diagnóstico de tumor palpebral por avaliação de fotos obtidas por câmera convencional versus câmera acoplada em smartphone. MÉTODOS: trinta e seis pacientes foram submetidos a exame externo e exame biomicroscópico para estabelecimento de diagnóstico clínico. As lesões foram fotografadas com câmera convencional Canon SX530 HS, digital de 16,8 megapixels e com câmera do smartphone modelo GALAXY S4. Todas as lesões foram ressecadas e submetidas a exame anatomopatológico. As imagens pré-operatórias foram analisadas à distância por dois especialistas em doenças palpebrais. Os dados dos diagnósticos presencial e dos teleavaliadores foram confrontados com o padrão ouro do diagnóstico histológico. RESULTADOS: as lesões mais frequentes foram constituídas por carcinoma basocelular (33,3%), queratose actínica (19,4%) e nevo (13,9%). O coeficiente de Kappa para diagnóstico de lesão maligna mostrou concordância entre os teleavaliadores nas imagens por câmera (0,68) e com smartphone (0,78). A acurácia do examinador presencial foi de 94,4%, a dos teleavaliadores nas imagens por câmera foi de 83,3% e as do smartphone variou entre 80,6% e 86,1%. Não houve diferença nos índices de acerto por uso de câmera ou smartphone quando comparado com o exame presencial. CONCLUSÃO: imagens obtidas por smartphone foram equiparáveis em relação à câmera convencional para uso em telemedicina para diagnóstico de lesão maligna palpebral.

Estudo comparativo entre imagens de câmera fotográfica convencional e smartphone para o telediagnóstico de tumores palpebrais / Comparative study between conventional camera images and smartphone images for eyelid tumor telediagnosis

RESUMO Objetivo: comparar a acurácia do diagnóstico de tumor palpebral por avaliação de fotos obtidas por câmera convencional versus câmera acoplada em smartphone. Métodos: trinta e seis pacientes foram submetidos a exame externo e exame biomicroscópico para estabelecimento de diagnóstico clínico. As lesões foram fotografadas com câmera convencional Canon SX530 HS, digital de 16,8 megapixels e com câmera do smartphone modelo GALAXY S4. Todas as lesões foram ressecadas e submetidas a exame anatomopatológico. As imagens pré-operatórias foram analisadas à distância por dois especialistas em doenças palpebrais. Os dados dos diagnósticos presencial e dos teleavaliadores foram confrontados com o padrão ouro do diagnóstico histológico. Resultados: as lesões mais frequentes foram constituídas por carcinoma basocelular (33,3%), queratose actínica (19,4%) e nevo (13,9%). O coeficiente de Kappa para diagnóstico de lesão maligna mostrou concordância entre os teleavaliadores nas imagens por câmera (0,68) e com smartphone (0,78). A acurácia do examinador presencial foi de 94,4%, a dos teleavaliadores nas imagens por câmera foi de 83,3% e as do smartphone variou entre 80,6% e 86,1%. Não houve diferença nos índices de acerto por uso de câmera ou smartphone quando comparado com o exame presencial. Conclusão: imagens obtidas por smartphone foram equiparáveis em relação à câmera convencional para uso em telemedicina para diagnóstico de lesão maligna palpebral.

ABSTRACT Objective: to compare the accuracy of eyelid tumor diagnosis obtained by evaluating conventional camera images with the ones obtained by evaluating smartphone images. Methods: from January 2016 to July 2017, 36 patients underwent face-to-face external assessments and biomicroscopic examinations to establish clinical diagnoses. The lesions were photographed using Canon PowerShot SX530 HS Digital Camera (16.8 Megapixels) and Samsung GALAXY S4 smartphone camera. All lesions were resected and submitted to anatomopathological examinations. Preoperative images were sent to two specialists in eyelid diseases and then remotely analyzed. Data from in-person diagnoses and telediagnoses were compared with the gold standard of histological diagnosis. Results: the most frequent lesions were basal cell carcinoma (33.3%), actinic keratosis (19.4%), and nevus (13.9%). Kappa coefficient for the diagnosis of malignant lesion showed agreement between the two tele-evaluators in the conventional digital camera images (0.68) and in the smartphone images (0.78). The face-to-face examiner's accuracy was of 94.4%; the tele-evaluators' accuracy in the conventional digital camera images was of 83.3% and in the smartphone images varied from 80.6% to 86.1%. Comparing the in-person diagnoses with the telediagnoses (obtained by evaluating conventional digital camera images or smartphone images), there was no significant difference in the hit rates. Conclusion: for eyelid tumor telediagnosis, images obtained using smartphone camera were equivalent to those obtained using conventional digital camera.

Profile of eyelid malignancy in a Tertiary Health Care Center in North India.

CONTEXT: The eyelids are affected by wide spectrum of benign and malignant lesions. Basal cell carcinoma (BCC) is the most common malignancy encountered while other malignant lesions such as sebaceous cell carcinoma and squamous cell carcinoma are rare. Data regarding geographical variation in trends of malignant eyelid tumors are presented in the current study. SETTINGS AND DESIGN: Prospective, longitudinal, observational study was conducted from December 2011 to October 2013. SUBJECTS AND METHODS: Patients with mass or growth involving eyelid managed by surgical intervention were selected for the study. Excised tissue masses were sent for histopathological examination. RESULTS: Fifty-two cases of extraocular tumors were operated during the study period, out of which 25 cases (48%) were of eyelids. Sixteen cases (64%) were benign, and remaining 9 cases (36%) were malignant eyelid neoplasms. Benign lesions exhibited female preponderance with male:female ratio of 1:2.25. No significant difference was noted in cases of malignant lesions with male:female ratio of 1:1.25. Most common benign tumor observed was sebaceous cyst. Sebaceous gland carcinoma (4 cases) was the most common malignant neoplasm followed by squamous cell carcinoma (2 cases) and BCC, orbital melanoma, and adenocarcinoma (1 case each). CONCLUSIONS: Sebaceous gland carcinoma is more common in North India as compared to BCC and squamous cell carcinoma.

Diagnosis of aggressive subtypes of eyelid basal cell carcinoma by 2-mm punch biopsy: prospective and comparative study.

OBJECTIVE: : to compare the accuracy of preoperative 2-mm punch biopsy at one site and at two sites in the diagnosis of aggressive subtypes of eyelid basal cell carcinoma (BCC). METHODS: : we randomly assigned patients to Group 1 (biopsy at one site) and Group 2 (biopsy at two sites). We compared the biopsy results to the gold standard (pathology of the surgical specimen). We calculated the sensitivity, specificity, positive predictive value, negative predictive value, accuracy and Kappa coefficient to determine the level of agreement in both groups. RESULTS: : we analyzed 105 lesions (Group 1: n = 44; Group 2: n = 61). The agreement was 54.5% in Group 1 and 73.8% in Group 2 (p = 0.041). There was no significant difference between the groups regarding the distribution of quantitative and qualitative variables (gender, age, disease duration, tumor larger diameter, area and commitment of margins). Biopsy at two sites was two times more likely to agree with the gold standard than the biopsy of a single site. CONCLUSIONS: : the accuracy and the performance indicators were better for 2-mm punch biopsy in two sites than in one site for the diagnosis of aggressive subtypes of eyelid BCC. OBJETIVO: comparar a acurácia da biópsia pré-operatória por trépano de 2mm em um sítio e em dois sítios no diagnóstico dos subtipos agressivos de carcinoma basocelular (CBC) palpebral. MÉTODOS: os pacientes foram distribuídos aleatoriamente em Grupo 1 (biópsia em um sítio) e Grupo 2 (biópsia em dois sítios). Os resultados das biópsias foram comparados com o padrão-ouro (exame anatomopatológico da peça cirúrgica). A sensibilidade, especificidade, valor preditivo positivo, valor preditivo negativo, precisão e coeficiente Kappa foram calculados para determinar o nível de concordância nos dois grupos. RESULTADOS: foram analisadas 105 lesões (Grupo 1: n = 44; Grupo 2: n = 61). A concordância foi de 54,5% no Grupo 1 e 73,8% no Grupo 2 (p-valor = 0,041). Não houve diferença significativa entre os grupos quanto à distribuição das variáveis quantitativas e qualitativas (sexo, idade, duração da doença, maior diâmetro do tumor, área e comprometimento de margens). A biópsia em dois sítios mostrou duas vezes mais chance de concordar com o padrão-ouro do que a biópsia de um sítio. CONCLUSÕES: a acurácia e os indicadores de desempenho foram melhores para a biópsia por trépano de 2 mm em dois sítios do que em um sítio para o diagnóstico dos subtipos agressivos de CBC palpebral.

Diagnosis of aggressive subtypes of eyelid basal cell carcinoma by 2-mm punch biopsy: prospective and comparative study / Diagnóstico dos subtipos agressivos de carcinoma basocelular palpebral pela biópsia por trépano de 2mm: estudo prospectivo e comparativo

ABSTRACT Objective : to compare the accuracy of preoperative 2-mm punch biopsy at one site and at two sites in the diagnosis of aggressive subtypes of eyelid basal cell carcinoma (BCC). Methods : we randomly assigned patients to Group 1 (biopsy at one site) and Group 2 (biopsy at two sites). We compared the biopsy results to the gold standard (pathology of the surgical specimen). We calculated the sensitivity, specificity, positive predictive value, negative predictive value, accuracy and Kappa coefficient to determine the level of agreement in both groups. Results : we analyzed 105 lesions (Group 1: n = 44; Group 2: n = 61). The agreement was 54.5% in Group 1 and 73.8% in Group 2 (p = 0.041). There was no significant difference between the groups regarding the distribution of quantitative and qualitative variables (gender, age, disease duration, tumor larger diameter, area and commitment of margins). Biopsy at two sites was two times more likely to agree with the gold standard than the biopsy of a single site. Conclusions : the accuracy and the performance indicators were better for 2-mm punch biopsy in two sites than in one site for the diagnosis of aggressive subtypes of eyelid BCC.

RESUMO Objetivo: comparar a acurácia da biópsia pré-operatória por trépano de 2mm em um sítio e em dois sítios no diagnóstico dos subtipos agressivos de carcinoma basocelular (CBC) palpebral. Métodos: os pacientes foram distribuídos aleatoriamente em Grupo 1 (biópsia em um sítio) e Grupo 2 (biópsia em dois sítios). Os resultados das biópsias foram comparados com o padrão-ouro (exame anatomopatológico da peça cirúrgica). A sensibilidade, especificidade, valor preditivo positivo, valor preditivo negativo, precisão e coeficiente Kappa foram calculados para determinar o nível de concordância nos dois grupos. Resultados: foram analisadas 105 lesões (Grupo 1: n = 44; Grupo 2: n = 61). A concordância foi de 54,5% no Grupo 1 e 73,8% no Grupo 2 (p-valor = 0,041). Não houve diferença significativa entre os grupos quanto à distribuição das variáveis quantitativas e qualitativas (sexo, idade, duração da doença, maior diâmetro do tumor, área e comprometimento de margens). A biópsia em dois sítios mostrou duas vezes mais chance de concordar com o padrão-ouro do que a biópsia de um sítio. Conclusões: a acurácia e os indicadores de desempenho foram melhores para a biópsia por trépano de 2 mm em dois sítios do que em um sítio para o diagnóstico dos subtipos agressivos de CBC palpebral.

Prognosis of eyelid sebaceous gland carcinoma based on the tumor (T) category of the American Joint Committee on Cancer (AJCC) classification.

The purpose of this study was to evaluate the clinical features and prognosis of eyelid sebaceous gland carcinoma (SGC) based on the T category of the American Joint Committee on Cancer (AJCC) classification (7th edition). This is a retrospective interventional case series study. Based on the T category of the AJCC classification, 191 patients with eyelid sebaceous gland carcinoma were classified as T1 (n = 1, 1 %), T2 (n = 111, 58 %), T3 (n = 76, 40 %), and T4 (n = 3, 2 %). Based on multivariate analysis, the factors predictive of regional lymph node metastasis included duration of symptoms >6 months (p = 0.04) and orbital tumor extension (p < 0.001). The factors predictive of systemic metastasis included orbital tumor extension (p < 0.001) and perivascular invasion (p = 0.007). The factor predictive of death due to systemic metastasis included orbital tumor extension (p < 0.001). Kaplan-Meier estimates of regional lymph node metastasis at 5 and 10 years, respectively, were 0 and 0 % for T1, 11 and 11 % for T2, 44 and 59 % for T3, and 100 and 100 % for T4 (p < 0.001). Kaplan-Meier estimates of systemic metastasis at 5 and 10 years, respectively, were 0 and 0 % for T1, 6 and 6 % for T2, 35 and 35 % for T3, and 100 and 100 % for T4 (p < 0.001). Kaplan-Meier estimates of death due to metastasis at 5 and 10 years, respectively, were 0 and 0 % for T1, 3 and 3 % for T2, 30 and 50 % for T3, and 100 and 100 % for T4 (p < 0.001). Primary tumor (T) category of the AJCC classification predicts the prognosis of patients with eyelid SGC. The risk of systemic metastasis and death increases with increasing tumor category.

Accuracy of Biopsy in Subtyping Periocular Basal Cell Carcinoma.

PURPOSE: To determine the accuracy of initial biopsy in the diagnosis of basal cell carcinoma (BCC) histologic subtype. METHODS: Retrospective histopathologic review of patients with a diagnosis of primary periocular BCC from 2006 to 2013 inclusive. RESULTS: A total of 174 primary BCCs were identified. BCCs were classified as nodular, superficial, or aggressive (including mixed cases with an aggressive component). Punch biopsies were used in 41% of cases, while the remaining patients underwent shave or incision biopsies. The final histologic subtypes at excision were nodular (59%), superficial (7%), nodular and superficial (7%), and aggressive (51%). The overall concordance between the BCC subtype identified in the biopsy specimen and the subsequent excision specimen was 54%. In total, there were 51 cases (29%) of BCC, which included aggressive subtypes, of which 52% of initial biopsies failed to detect an aggressive component. There were 45 cases (26%) of mixed BCC, and an aggressive histologic subtype was present in 73% of these cases. CONCLUSIONS: The accuracy of initial biopsy for BCC histologic subtype at excision is highest for nodular BCC. For aggressive BCC, biopsy was able to detect the aggressive component in only 48% of cases. This may have implications for choice of treatment modality.

[Endocrine mucin-producing sweat gland carcinoma. three case reports with a brief review of the literature]. / Endokrines muzinproduzierendes Schweißdrüsenkarzinom. Drei Fallberichte mit kurzer Literaturübersicht.

Endocrine mucin-producing sweat gland carcinoma (EMPS) is a rare low-grade sweat gland carcinoma with an infiltrating growth pattern. It occurs mostly in women and shows a predilection for the periorbital region. Histopathologically, the tumor shows analogous features to endocrine ductal carcinoma/solid papillary carcinoma of the breast and shares some clinical and morphological similarities with primary mucinous carcinoma of the skin. The tumor is characterized by large monomorphous epithelial cells with little nuclear pleomorphism and only a few mitotic figures. The solid cystic tumor shows mucin-filled small cystic spaces, cribriform areas and expresses the neuroendocrine markers synaptophysin, chromogranin and neuron-specific enolase with varying staining intensities. The tumor cells are also positive for estrogen and progesterone receptors. We present three cases of this rare tumor with typical clinical, histopathological and immunohistochemical findings, give a short summary of the literature and discuss the most relevant differential diagnoses.

Number of excisions required to obtain clear surgical margins and prognostic value of AJCC T category for patients with eyelid melanoma.

AIMS: To determine the number of excisions needed to achieve clear margins and the prognostic value of the 7th edition of American Joint Committee on Cancer (AJCC) classification for eyelid melanoma. METHODS: Retrospective chart review of consecutive patients treated for eyelid melanoma from January 2006 through May 2013 by the senior author at a tertiary care cancer centre. RESULTS: Of the 64 patients (25 men and 39 women), clear surgical margins were achieved with a single excision in 38 patients (62%), 2 excisions in 21 patients (34%), and 3 excisions in 2 patients (3%). Need for repeat excision was not correlated with the size of the surgical margin (p=0.14) or AJCC TNM classification (p=0.15). Nodal disease at presentation was significantly associated with T category greater than T2b (p=0.0026) and shorter time to disease progression (p=0.007). Patients followed for a minimum of 1 year with T category greater than T2b had a significantly higher risk of nodal or distant metastasis (p=0.0061). CONCLUSIONS: More than a third of patients with eyelid melanoma required more than 1 excision to achieve clear margins, supporting delayed reconstruction for eyelid melanoma. Nodal metastasis at presentation was significantly correlated with AJCC T category and time to progression.

Conceptos actuales en la disfunción de las glándulas de meibomio / Current concepts about the meibomian gland dysfunction

Los científicos han estado interesados en el estudio de las secreciones de las glándulas de Meibomio desde hace muchos años. Enfermedades asociadas, como los cánceres y la blefaritis posterior, se han observado en la literatura médica, desde la primera parte del siglo XX. Sin embargo, el término "disfunción de las glándulas de Meibomio" fue introducida por Korb y Henríquez en 1980. No existía una definición establecida publicada en la literatura hasta que más de 50 expertos internacionales participaron en un taller, que tuvo lugar durante un período de dos años, donde se llegó a definir como una anormalidad crónica y difusa de estas glándulas, comúnmente caracterizada por la obstrucción del conducto terminal y cambios cualitativos/cuantitativos en la secreción de esta. Esto puede resultar en la alteración de la película lagrimal, síntomas de irritación ocular, inflamación clínicamente aparente y enfermedad de la superficie ocular. Es en el mismo Taller Internacional, donde se decide clasificar de acuerdo con los cambios anatómicos, fisiopatológicos, o la gravedad de la enfermedad, donde la forma obstructiva fue la más generalizada. Constituye una afección frecuente con disminución de la calidad de vida y perjuicios potencialmente graves para el bienestar humano.

Scientists have been interested in the study of secretions from meibomian glands for many years. Related illnesses as cancer and posterior blepharitis have been found in the medical literature since the first half of the 20th century. However, the term «meibomian gland dysfunction¼ was introduced by Korb and Henríquez in 1980. There was not a set definition published in the literature until over 50 international experts participated in a workshop held for 2 years. It was there where this disorder was finally defined as a chronic diffuse anomaly occurred in these glands, which is generally characterized by obstructed terminal duct and qualitative/quantitative changes in the gland secretion. This may cause altered lachrymal film, ocular irritation symptoms, clinically apparent inflammation and ocular surface disease. In the same international workshop, it was decided to classify meibomian gland dysfunction according to the anatomical, physiopathological changes or to the severity of the disease, being the obstructive type the most generalized form. This is a frequent illness that reduces the quality of life and causes potentially serious damages for the human wellbeing.

Correlation of American Joint Committee on Cancer T category for eyelid carcinoma with outcomes in patients with periocular Merkel cell carcinoma.

PURPOSE: Merkel cell carcinoma is a rare but potentially deadly cancer of the eyelid. To date, no studies have reported on clinical parameters at initial presentation of the eyelid tumor that may correlate with disease-free survival (DFS). The purpose of this study was to determine whether the American Joint Committee on Cancer (AJCC) T category for eyelid carcinoma correlates with metastasis and DFS in patients with Merkel cell carcinoma of the periocular region. METHODS: This is a retrospective cohort study from a tertiary referral cancer center. All consecutive patients treated for eyelid or periocular Merkel cell carcinoma between November 1, 1998, and November 1, 2012, were reviewed. The main outcome measures included AJCC T category for eyelid carcinoma and Merkel cell carcinoma at presentation, nodal metastasis at presentation, metastasis during follow up, and DFS. RESULTS: The study included 18 patients, 7 men and 11 women, with median age of 68.5 years. The AJCC T categories for both eyelid carcinoma and Merkel cell carcinoma were significantly correlated with DFS. Using the T categories for eyelid carcinoma, when TX and T2a were grouped into a single category and T2b and T3a into another category, the estimated DFS rate at 3 years was 100% for patients with TX or T2a lesions and 57% for patients with T2b or T3a lesions (p=0.0298). Four patients (22%) had lymph node metastasis at presentation. Presence of lymph node metastasis at presentation was the strongest single predictor of shorter DFS and an increased risk of metastasis during follow up (p=0.0222). CONCLUSIONS: The AJCC eyelid carcinoma T at presentation correlates with DFS in patients with Merkel cell carcinoma of the periocular region. The DFS rate at 3 years was significantly worse for patients with T2b or more extensive tumors by eyelid carcinoma T category. Presence of lymph node metastasis at presentation was predictive of shorter DFS and an increased risk of metastasis during follow up.

Prognostic value of clinical and pathologic T stages defined by the American Joint Committee on Cancer for eyelid sebaceous carcinoma in Korea.

PURPOSE: To investigate whether the clinical and pathologic T category classification, as defined by the American Joint Committee on Cancer (AJCC), is associated with lymph nodes (LN) or distant metastasis in patients with eyelid sebaceous carcinoma. METHODS: Forty patients treated for eyelid sebaceous carcinoma at Seoul National University Hospital between March 1999 and December 2011 were retrospectively staged according to the AJCC 7th edition criteria. Three different primary tumor classifications-(1) clinical tumor size at presentation; (2) clinical AJCC T stage (cT) at presentation based not only on size, but also on the extent of involvement and (3) pathologic AJCC T stage (pT) based on histopathological examination-were compared and evaluated with regard to their association with LN or distant metastasis. RESULTS: In univariate analysis, the AJCC cT (p = 0.005) and pT (p = 0.029) categories were significantly associated with metastasis, but clinical tumor size alone did not correlate with metastasis (p = 0.093). Clinical and pathologic AJCC stage T2b or higher tumors were significantly associated with metastasis compared to stage T1 or T2a tumors [odds ratio cT, 8.00 (p = 0.025); pT, 6.91 (p = 0.028)]. CONCLUSIONS: The clinical and pathologic AJCC T category has predictive value for LN or distant metastasis in eyelid sebaceous carcinoma. However, the clinically assessed largest tumor dimension alone is not an effective predictive factor. Clinicians should be aware of the increased risk of metastasis in patients with tumors of stage T2b or higher at initial presentation.

Histological subtypes of periocular basal cell carcinoma.

BACKGROUND: To determine the proportion of different subtypes of periocular BCC in South Australia. DESIGN: Retrospective review. PARTICIPANTS: One thousand seven hundred thirteen consecutive periocular basal cell carcinoma (BCC) excision specimens. METHODS: Histological analysis of consecutive periocular BCC specimens. MAIN OUTCOME MEASURES: Date of resection, patient age at resection, gender, tumour location, histological subtype and perineural invasion. RESULTS: From 2006 to 2012, a total of 1713 consecutive periocular BCC excision specimens were analysed. The mean age at resection was 68.8 years (median: 71, range: 21-101). Most specimens (56.4%) were removed from male patients. 52.7% involved the lower eyelid, 29.0% the medial canthus, 10.9% the lateral canthus and 7.5% the upper eyelid. The main histological subtypes identified were nodular (65.7%), infiltrative (17.5%), superficial (12.6%) and micronodular (4.2%). Of the specimens, 25.6% had more than one subtype. The most common subtype combinations were nodular with infiltrative (49.7%), and nodular with superficial (26.0%). CONCLUSIONS: The majority of periocular BCC were located on the lower lid and classified histologically as nodular. Infiltrative BCC occurred more frequently than the superficial subtype. As the proportion of mixed BCC containing aggressive subtypes is high, surgical excision with margin control should be considered for periocular BCC.

Impact of AJCC 'T' designation on risk of regional lymph node metastasis in patients with squamous carcinoma of the eyelid.

BACKGROUND/AIMS: Squamous cell carcinoma (SCC) of eyelid is the second most common cancer of the eyelid with the potential for nodal metastasis. The purpose of this report is to determine whether primary tumour size and 'T' designation in the American Joint Committee on Cancer (AJCC) staging system, 7th edition, correlate with the risk of regional nodal metastasis in patients with eyelid SCC. METHODS: Sixty-five consecutive patients with eyelid SCC treated by one ophthalmologist from March 1999 through July 2011 were included in this retrospective cohort study. Disease was staged using the AJCC 7th edition criteria based on clinical, pathological and radiographical data. Main outcome measures included regional lymph node metastasis at presentation, local recurrence, distant metastasis and survival at last follow-up. RESULTS: 40 men and 25 women had a median age of 67.0 years (range 41-89). TNM designations at presentation per the AJCC 7th edition were as follows: T1N0M0, 6 patients; T2aN0M0, 11 patients; T2bN0M0, 17 patients; T2bN1M0, 2 patients; T3aN0M0, 22 patients; T3bN0M0, 2 patients; T3bN1M0, 1 patient; T4N0M0, 3 patients; and T4N1M0, 1 patient. Median follow-up was 27 months (range 1-150). Four patients had nodal metastasis at presentation. Two of these four patients had T2bN1M0 disease, one had T3bN1M0 disease and one had T4N1M0 disease. Two patients, with T3aN0M0 and T4N0M0 tumours, respectively, at presentation, developed lymph node metastasis at 2 weeks and 8.4 months, respectively, after tumour excision. The four patients who had lymph node metastases at presentation and the two who developed lymph node metastases during follow-up had tumours ≥18 mm in greatest dimension or T2b or higher at presentation. Seven local recurrences were observed during follow-up. Two-year and 3-year recurrence-free survival rates were 93% (95% CI 80% to 98%) and 82% (95% CI 63% to 92%), respectively. No distant metastasis or tumour-related death was observed during follow-up. The 2-year and 3-year disease-free survival rates were 90% (95% CI 77% to 96%) and 79% (95% CI 61% to 89%), respectively. CONCLUSIONS: Regional nodal metastases were observed among patients who presented with tumours >T2b. Tumour size and the AJCC TNM designations correlate with metastasis and should be reported more often for eyelid SCCs to allow comparisons across centres.

Eyelid benign and malignant tumors: issues in classification, excision and reconstruction.

In the orbital region the variety of tumors is so vast that even an expert oculoplastic surgeon may be deceived. The various tumors may be classified as benign, precancerous and malignant. Approximately 5-10% of all skin cancers occur in the eyelids. Incidence studies indicate that basal cell carcinoma is the most frequent malignant eyelid tumor, followed by squamous cell carcinoma, sebaceous gland carcinoma and malignant melanoma. Malignant neoplasms represent the leading cause of plastic reconstruction in orbital region, followed by cicatricial retraction, post-traumatic loss of tissue, congenital colobomas. Aim of this review is to classify benign and malignant lesions; to consider the surgical removal approach to the lesion (Mohs micrographic surgery, frozen sections, biopsy, immediate removal and reconstruction with permanent sections) and finally to consider reconstruction techniques with grafts and flaps.

[Eyelid reconstruction after full-thickness resections in benign and malignant tumors].

Full-thickness eyelid defect closure requires appropriate reconstruction, function recovery and acceptable cosmetic result. The aim of the study was to study the results of eyelid reconstruction after full-thickness resections in different benign and malignant tumors. 241 patients (63,5% females, 36,5% males) who underwent full-thickness resectioh of the lower or the upper eyelid due to tumor with primary defect closure were enrolled in the study. Eyelid resection was performed within visually clear tissue 2 mm away of the tumor border in benign and at least 3 mm in malignant lesions. Presented results of different techniques of eyelid reconstruction after full-thickness resections show good functional and cosmetic rehabilitation of patients and low complication rate.

American Joint Committee on Cancer T category for eyelid sebaceous carcinoma correlates with nodal metastasis and survival.

PURPOSE: To determine whether T category of the American Joint Committee on Cancer (AJCC) TNM staging system for eyelid carcinoma, 7th edition, correlates with lymph node metastasis, distant metastasis, and survival in patients with sebaceous carcinoma of the eyelid. DESIGN: Retrospective, cohort study. PARTICIPANTS: Fifty consecutive patients treated by 1 author (BE) for eyelid sebaceous carcinoma between May 1999 and August 2010. METHODS: Each tumor was staged according to the AJCC 7th edition TNM criteria. The Kaplan-Meier method was used to determine associations between disease-specific survival and (1) T category at presentation, (2) lymph node metastasis, and (3) distant metastasis. MAIN OUTCOME MEASURES: T category at presentation, nodal metastasis, survival. RESULTS: The study included 37 women and 13 men (median age, 68.5 years; range, 44-86 years). Forty-four patients were white, 5 were Hispanic, and 1 was Asian. TNM designations were TXN0M0, 7 patients; T1N0M0, 4 patients; T2aN0M0, 12 patients; T2bN0M0, 11 patients; T2bN1M0, 2 patients; T2bN1M1, 1 patient; T3aN0M0, 2 patients; T3aN1M0, 5 patients; T3bN0M0, 1 patient; T3bN1M0, 1 patient; T3bN0M1, 2 patients; T4N0M0, 1 patient; and T4N0M1, 1 patient. T category at presentation was significantly associated with lymph node metastasis (P = 0.0079). No tumors with T category better than T2b or smaller than 9 mm in greatest dimension were associated with nodal metastasis. Five patients (10%) died of disease during follow-up. Their TNM designations were T2bN1M1, 1 patient; T3bN0M1, 2 patients; T4N0M0, 1 patient; and T4N0M1, 1 patient. No tumors smaller than 12 mm in greatest dimension were associated with distant metastasis or death. T category was significantly associated with disease-specific survival (P = 0.0009). Disease-specific survival was poorer among patients with T category of T3a or worse (P = 0.035). CONCLUSIONS: T category in the 7th edition of the AJCC TNM staging system for eyelid carcinoma correlates with outcomes in patients with sebaceous carcinoma of eyelid. On the basis of the present findings, it seems reasonable to recommend sentinel lymph node biopsy or at least strict regional lymph node surveillance for patients with eyelid sebaceous carcinoma with tumors of T category T2b or worse or 10 mm or more in greatest dimension.