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.

中文翻译：

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眼睑皮脂腺癌的莫氏显微照相术：360名患者的多中心队列

背景

对于眼睑皮脂腺癌（SC）进行Mohs显微外科手术（MMS）或广泛局部切除术（WLE）的决定是有争议的。

客观的

为了比较最初接受MMS与WLE治疗的眼睑SC患者的局部复发，转移和与肿瘤相关的死亡率。

方法

多中心队列研究。审查了医疗记录中与复发，转移和肿瘤相关的死亡率相关的因素。对所有符合条件的患者进行了随访。在控制所有混杂因素后，通过Cox分析确定了初始手术方式对预后的影响。

结果

在该队列中的360名患者中，有115名（31.9％）接受了MMS作为主要切除，而245名（68.1％）接受了WLE。在中位随访期为60.0个月之后，MMS组中有18例患者（15.7％），WLE组中有97例患者（39.6％）观察到局部复发。接受MMS的9例（7.8％）和接受WLE的38例（15.5％）发生转移。MMS组共有6例患者（5.2％），WLE组21例（8.6％）因转移性SC死亡。多变量Cox回归表明，与WLE组相比，MMS组表现出更有利的局部复发控制（危险比[HR]为0.42； 95％置信区间[CI]为0.24-0.73；P  = .002），但转移相当率（HR，1.38; 95％CI，0.60-3.18; P = 0.453）和可比的肿瘤相关死亡率（HR，1.70； 95％CI，0.59-4.93；P  = .329）。然而，这种有益效果对于患有页面状上皮内瘤变的患者而言并不显着（HR，1.73； 95％CI，0.37-8.21；P  = .488）。

局限性

研究的回顾性。

结论

对于没有眼眶受累的眼睑SC应建议采用MMS，以实现复发控制。但是，这种手术方法并没有改变转移或肿瘤相关死亡率的长期结果。患有页面状上皮内瘤变的患者可能需要辅助措施。