Efficient DNA/RNA extraction from tarsal plates by SK mill, a freeze-crush apparatus.

The tarsal plate is an eyelid tissue that maintains lid structure from inside the upper/lower eyelids, and it surrounds the meibomian glands and supports their unique secretion mechanism. Sebaceous carcinoma, a malignant eyelid tumour, can sometimes develop from the meibomian glands and is usually excised together with the tarsal plate during surgery, so the tarsal plate serves as a control research tissue. However, since the plate is thick, hard and heterogeneous with few cells, obtaining enough genomic DNA and/or total RNA is often difficult. Therefore, we attempted to establish an efficient protocol to obtain DNA and RNA simultaneously by comparing the combinations of homogenization (mortar/pestle, pellet pestle or SK mill) and purification (organic solvent or spin column) methods using rabbit tarsal plates. Based on the yield, quality and hands-on time, the SK mill and spin column was found to be the most efficient combination. We then applied the established protocol to extract DNA/RNA from six human tarsal-plate samples and succeeded in generating high-quality exome and transcriptome datasets via a next-generation sequencer with sufficient coverage and meibomian gland-specific expression of representative genes, respectively. Our new findings will provide ideal reference data for future genetic and gene-expression studies of sebaceous carcinoma.

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

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 with 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 control for all confounders. RESULTS: Of the 360 patients included in this cohort, 115 (31.9%) underwent MMS as primary resection, whereas 245 (68.1%) underwent WLE. After a median follow-up period of 60.0 months, local recurrence was observed in 18 patients (15.7%) in the MMS group and 97 patients (39.6%) in the WLE group. Metastasis occurred in 9 patients (7.8%) who underwent MMS and 38 (15.5%) who underwent WLE. In all, 6 patients in the MMS group (5.2%) and 21 in the WLE group (8.6%) died of metastatic SC. Multivariable Cox regression indicated that compared with the WLE group, the MMS group exhibited more favorable local recurrence control (hazard ratio [HR], 0.42; 95% confidence interval [CI], 0.24-0.73; P = .002) but a comparable metastasis rate (HR, 1.38; 95% CI, 0.60-3.18; P = .453) and comparable tumor-related mortality (HR, 1.70; 95% CI, 0.59-4.93; P = .329). However, this beneficial effect became nonremarkable for patients with pagetoid intraepithelial neoplasia (HR, 1.73; 95% CI, 0.37-8.21; P = .488). LIMITATIONS: Retrospective nature of the study. CONCLUSION: MMS should be proposed for eyelid SC without orbital involvement to achieve recurrence control; however, this surgical procedure did not change the long-term outcomes in terms of metastasis or tumor-related mortality. Patients with pagetoid intraepithelial neoplasia may require adjuvant measures.

Contemporary update of overall prognosis and nomogram to predict individualized survival for Chinese patients with eyelid sebaceous carcinoma.

BACKGROUND: The prognosis of Chinese patients with eyelid sebaceous carcinoma (SC) has not been updated for >3 decades. The prognostic predictors are multifactorial, and there is no validated prognostic model for eyelid SC. METHODS: This study included 238 consecutive patients with eyelid SC. All eligible patients were followed up for metastasis and mortality. The predictors of tumor-related survival were explored by Cox analyses. A prognostic nomogram was developed and validated using bootstrap resampling. The predictive accuracy and discriminative ability were compared between the nomogram and the Tumor, Node, Metastasis (TNM) staging system. FINDINGS: After a median follow-up period of 55.5 months, 27 (11.3%) patients died of metastatic SC, with a median survival time of 48.0 months. The 5-year and 10-year tumor-related survival rates were 88.1% and 77.9%, respectively. Orbital involvement (HR: 3.11, p = .022), the greatest tumor basal diameter (HR: 1.06, p = .003), the presence of pagetoid spread (HR: 2.90, p = .017), and having lymph node metastasis at initial diagnosis (HR: 13.66, p < .001) were independent risk factors for tumor-related death. A nomogram integrating these 4 factors was developed with a C-index of 0.887, which is significantly better than that of the TNM staging system (p = .002). The risk groups stratified by nomogram scores (p < .001 (low vs intermediate risk); p = .001 (intermediate vs high risk)) displayed better discrimination ability than TNM staging (T1 vs T2: p = .358; T2 vs T3: p = .171; T3 vs T4: p < .001) in patients at an early stage. INTERPRETATION: The prognosis of Chinese patients with eyelid SC has improved over the last 3 decades, and it is comparable to that of patients from other countries. This nomogram provides more accurate individualized estimates of survival for eyelid SC patients and may guide clinicians in their therapeutic decisions.

Carcinoma sebáceo de párpado. Reporte de un caso / Sebaceous carcinoma of the eyelid. Case report

Objetivo: Reportar el caso de una paciente con carcinoma sebáceo de párpado y revisar la literatura. Diseño del estudio: Reporte de caso. Métodos: Se reporta un caso de una paciente con diagnóstico de carcinoma sebáceo de párpado que fue remitida a la Clínica de Oftalmología San Diego Medellín-Colombia, a la consulta de Oncología ocular en el año 2015. Se realizó una revisión detallada de la historia clínica, se tomaron fotos a color previa firma de consentimiento informado por parte de la paciente y se realizó biopsia e inmunohistoquímica respectiva. Se cuenta con la aprobación el comité de ética médica de la Universidad Pontificia Bolivariana. Resultados: Reporte de carcinoma sebáceo de párpado. Mujer de 66 años a la que se le hizo diagnóstico de carcinoma sebáceo de párpado luego de resección y se confirmó con el estudio anatomopatológico y de inmunohistoquímica. Se realizaron estudios de extensión en busca de metástasis a distancia. Conclusión: El carcinoma sebáceo de párpado es una entidad poco frecuente en la práctica clínica oftalmológica siendo estas lesiones fácilmente confundidas con lesiones benignas como chalazión y blefaroconjuntivitis por la poca familiaridad del especialista con la enfermedad. Es necesario tener un alto índice de sospecha y saber que existe para tratar esta entidad de manera oportuna evitando intervenciones no indicadas en este tipo de lesión.

Objective: To report the case of a patient with sebaceous carcinoma of the eyelid and literature review. Study Design: Case report. Methodology: A case of a patient diagnosed with sebaceous carcinoma of the eyelid which was referred to the oncology service to Clinic of Ophthalmology San Diego Medellin-Colombia in 2015. A detailed review of the medical history and photography documentation was done. Results: Sebaceous carcinoma of the eyelid was reported. A woman of 66 years old who has had diagnosis of eyelid sebaceous carcinoma after resection and confirmed with histopathologic and immunohistochemical study. Extension studies were conducted in order to rule out metastases. Conclusion: The sebaceous carcinoma of the eyelid is a rare entity in the ophthalmological setting and could be easily confused with benign lesions such as blepharitis and chalazion for those ophthalmologists unfamiliar with this condition. A high index of suspicion of this entity is recommended in a timely manner to avoid interventions that are not indicated in this type of lesion.