Mohs micrographic surgery versus wide local excision for sebaceous adenocarcinoma of the eyelid

 – analysis of a national database:

Publication date: Available online 2 March 2019

Source: Journal of Plastic, Reconstructive & Aesthetic Surgery

Author(s): Kevin Phan, Asad Loya

Abstract

Background

Sebaceous adenocarcinomas are rare and potentially aggressive tumors which typically arise in the periocular region. Surgical treatments for eyelid sebaceous adenocarcinomas include Mohs micrographic surgery (MMS) and wide local excision (WLE). The objective of this study was to compare long-term survival outcomes of MMS versus WLE techniques for eyelid sebaceous adenocarcinomas.

Methods

A retrospective analysis was performed of the Surveillance, Epidemiology, and End Results (SEER) cancer registry database. We analysed cases diagnosed from 1998–2015 within the database. Patients diagnosed with sebaceous adenocarcinoma were identified using ICD codes. Cases were limited to primary sebaceous adenocarcinomas involving specifically the eyelid region. The main outcomes were assessed by Kaplan-Meier (KM) survival and Cox proportional hazards model.

Results

67 cases of MMS were compared with 114 cases of WLE for eyelid sebaceous carcinoma. Overall KM survival rates for MMS compared to WLE at 5-year (75.6% vs 70.3%) and 10-year follow-up (69.2% vs 46.9%) did not significantly differ via log rank (P=0.062). Similarly, after adjusting for demographic, tumor, and treatment characteristics, there was no significant difference in cancer-specific survival (HR 0.45, 95% CI 0.03-6.92, P=0.57) and overall-survival (HR 0.94, 95% CI 0.50-1.74, P=0.83) when MMS surgical technique was compared with WLE techniques.

Conclusions

Our adjusted analyses demonstrated no differences in overall survival or cancer-adjusted survival for patients with eyelid sebaceous adenocarcinomas treated with MMS compared with WLE. In areas requiring preservation of tissue due to cosmetic or functional purposes, MMS is a reasonable surgical approach.