Elsevier

Ophthalmology

Volume 108, Issue 11, November 2001, Pages 2088-2098
Ophthalmology

Article for CME credit
Treatment options and future prospects for the management of eyelid malignancies: An evidence-based update

https://doi.org/10.1016/S0161-6420(01)00796-5Get rights and content

Abstract

Purpose

To provide evidence-based clinical recommendations for treatment options and future prospects for the management of common malignant eyelid tumors, including global ratings for the strength of published evidence supporting them.

Clinical relevance

Approximately 5% to 10% of all skin cancers occur in the eyelid. 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. Many therapeutic methods have been suggested to combat the morbidity and mortality associated with these lesions.

Literature reviewed

A MEDLINE and PubMed literature search (1966–1999) was conducted for English language abstracts and appropriate (selected) full-text references retrieved regarding treatment of malignant eyelid tumors. These sources then were used to prepare recommendations for patient care. Each recommendation was rated according to: (1) its importance in the care process and (2) the strength of evidence supporting the given recommendation.

Results

All recommendations were rated as level A (very important to patient-care outcome). For basal cell carcinoma, squamous cell carcinoma, and sebaceous gland carcinoma, the published evidence supporting two recommendations (Mohs’ micrographic surgery or excision with frozen-section control) were graded as I (providing strong evidence in support of a recommendation). For sebaceous gland carcinoma, the recommendations also included conjunctival map biopsies. The published evidence supporting all other recommendations for these three eyelid tumors were graded II (substantial evidence in support of a recommendation), primarily because of the small numbers of patients in each clinical study. For malignant melanoma, the recommendation for therapy (i.e., excision with variable margins depending on tumor thickness) was based on published papers individually variably rated as I, II, and III, reflecting ongoing debate as to the best method of therapy.

Conclusions

Published reports regarding the treatment of malignant eyelid tumors include a myriad of treatment options. The strongest evidence favors complete surgical removal using histologic controls for verifying tumor-free margins of excision.

Section snippets

Methods

The authors conducted a MEDLINE and PubMed literature search of articles published in English from 1966 through 1999. Search words included eyelid, basal cell carcinoma, squamous cell carcinoma, sebaceous gland carcinoma, malignant melanoma, Mohs’, radiation, cryotherapy, chemotherapy, therapy, and malignant eyelid tumor. Additional pertinent articles from a variety of textbooks and monographs were reviewed. In total, 110 articles and sources were reviewed.

As outlined by Wilkinson,2

Discussion

Current management of many anterior and posterior segment disorders is based on prospective and retrospective clinical studies. Ophthalmologists, both comprehensive and subspecialized, rely on data from these studies to determine the most appropriate and best clinical management. Many ophthalmologists, however, are not intimately familiar with the literature on which these clinical recommendations are founded. A recent study by Wilkinson,2 for example, affirmed that optimal trials regarding

Conclusions

Evidence-based medicine will continue to evolve as an important method to improve many aspects of medical care, including ophthalmology. For each of the four malignant eyelid tumors discussed in this paper, retrospective and prospective studies have provided important information and recommendations regarding treatment options and future prospects for their management. Based on these studies, the recommendations provided herein should help practitioners to diagnose and manage malignant eyelid

References (106)

  • P.J Fitzpatrick et al.

    Basal and squamous cell carcinoma of the eyelids and their treatment by radiotherapy

    Int J Radiat Oncol Biol Phys

    (1984)
  • F.T Fraunfelder et al.

    Results of cryotherapy for eyelid malignancies

    Am J Ophthalmol

    (1984)
  • J.C Alex et al.

    Gamma-probe guided localization of lymph nodes

    Surg Oncol

    (1993)
  • R Folberg et al.

    Recurrent and residual sebaceous carcinoma after Mohs’ excision of the primary lesion

    Am J Ophthalmol

    (1987)
  • A.M Putterman

    Conjunctival map biopsy to determine pagetoid spread

    Am J Ophthalmol

    (1986)
  • R.D Lisman et al.

    Sebaceous carcinoma of the eyelids. The role of adjunctive cryotherapy in the management of conjunctival pagetoid spread

    Ophthalmology

    (1989)
  • R.L Hendley et al.

    Primary radiation therapy for meibomian gland carcinoma

    Am J Ophthalmol

    (1979)
  • W.R Nunery et al.

    Recurrence of sebaceous carcinoma of the eyelid after radiation therapy

    Am J Ophthalmol

    (1983)
  • T.G Salopek et al.

    Management of cutaneous malignant melanoma by dermatologists of The American Academy of Dermatology. II. Definitive surgery for malignant melanoma

    J Am Acad Dermatol

    (1995)
  • L.D Turkula et al.

    Limited or selective nodal dissection for malignant melanoma of the head and neck

    Am J Surg

    (1984)
  • J.J Grob et al.

    Randomised trial of interferon alpha-2a as adjuvant therapy in resected primary melanoma thicker than 1.5 mm without clinically detectable node metastases

    Lancet

    (1998)
  • B Hancock et al.

    Adjuvant interferon-alpha in malignant melanomacurrent status

    Cancer Treat Rev

    (2000)
  • K.G Riedel et al.

    Basal cell carcinoma

  • J.E Wolf et al.

    Tumor angiogenic factor and human skin tumors

    Arch Dermatol

    (1975)
  • K.L Piest

    Malignant lesions of the eyelids

    J Dermatol Surg Oncol

    (1992)
  • G.R Howard et al.

    Clinical characteristics associated with orbital invasion of cutaneous basal cell and squamous cell tumors of the eyelid

    Am J Ophthalmol

    (1992)
  • R.J Gorlin et al.

    Multiple nevoid basal-cell epithelioma, jaw cysts and bifid riba syndrome

    N Engl J Med

    (1960)
  • H.S Zackheim et al.

    Nevoid basal cell carcinoma syndromesome histologic observations on the cutaneous lesions

    Arch Dermatol

    (1966)
  • H Lindeberg et al.

    The nevoid basal cell carcinoma syndromehistopathology of the basal cell tumors

    J Cutan Pathol

    (1983)
  • T Horio et al.

    Linear unilateral basal cell nevus with comedo-like lesions

    Arch Dermatol

    (1978)
  • N Mora

    Surgical and aesthetic considerations of cancer of the skin in the Black American

    J Dermatol Surg Oncol

    (1986)
  • D Leffell et al.

    Aggressive-growth basal cell carcinoma in young adults

    Arch Dermatol

    (1991)
  • K.H Kraemer et al.

    Xeroderma pigmentosumcutaneous, ocular, and neurologic abnormalities in 830 published cases

    Arch Dermatol

    (1987)
  • K.R Scott et al.

    Premalignant lesions and squamous cell carcinoma

  • W.I Cottel

    Perineural invasion by squamous-cell carcinoma

    J Dermatol Surg Oncol

    (1982)
  • P.P Vitaliano et al.

    The relative importance of risk factors in nonmelanoma carcinoma

    Arch Dermatol

    (1980)
  • M.T Doxanas et al.

    Sebaceous gland carcinomareview of 40 cases

    Arch Ophthalmol

    (1984)
  • D Schlernitzauer et al.

    Sebaceous gland carcinoma of the eyelid following radiation therapy for cavernous hemangioma of the face

    Arch Ophthalmol

    (1976)
  • R.P Howrey et al.

    Sebaceous gland carcinomaa subtle second malignancy following radiation therapy in patients with bilateral retinoblastoma

    Cancer

    (1998)
  • M Boniuk et al.

    Sebaceous carcinoma of the eyelids, eyebrow, caruncle, and orbit

    Trans Am Acad Ophthalmol Otolaryngol

    (1968)
  • E.H Sacks et al.

    Diagnosis and management of sebaceous gland carcinoma

  • R.P Yeatts et al.

    Sebaceous carcinoma of the eyelidpitfalls in diagnosis

    Ophthal Plast Reconstr Surg

    (1985)
  • J.A Shields et al.

    Meibomian gland carcinoma presenting as a lacrimal gland tumor

    Arch Ophthalmol

    (1974)
  • T.B Fitzpatrick et al.

    The melanocytecytology and cytochemistry

    J Invest Dermatol

    (1959)
  • C.E Margo

    Pigmented lesions of the eyelid

  • M.C Mihm et al.

    The clinical diagnosis, classification, and histogenetic concepts of the early stages of cutaneous malignant melanomas

    N Engl J Med

    (1981)
  • D.M Wayte et al.

    Melanotic freckle of Hutchinson

    Cancer

    (1968)
  • W.H Clark et al.

    The histiogenesis and biologic behavior of primary malignant melanomas of the skin

    Cancer Res

    (1969)
  • A Breslow

    Thickness, cross-sectional areas and depth of invasion in the prognosis of cutaneous melanoma

    Ann Surg

    (1970)
  • J.W Payne et al.

    Basal cell carcinoma of the eyelidsa long-term follow-up study

    Arch Ophthalmol

    (1969)
  • Cited by (0)

    Supported in part by an unrestricted grant from Research to Prevent Blindness, Inc., New York, New York.

    View full text