Mohs micrographic surgery achieves better recurrence control in eyelid sebaceous carcinoma

26 May 2019

A recent study suggests the use of Mohs micrographic surgery (MMS) for eyelid sebaceous carcinoma (SC) without orbital involvement to help prevent its recurrence. However, MMS has not succeeded in changing the long-term outcomes regarding metastasis or tumour-related mortality.

There were 360 patients included in this study, of whom 115 (31.9 percent) underwent MMS as primary resection and 245 (68.1 percent) underwent wide local excision (WLE).

Eighteen patients (15.7 percent) who underwent MMS and 97 (39.6 percent) who underwent WLE had local recurrence after a median follow-up period of 60.0 months. Nine patients (7.8 percent) in the MMS group and 38 (15.5 percent) in the WLE group had metastasis. Death due to metastatic SC occurred in six (5.2 percent) and 21 patients (8.6 percent) in the MMS and WLE groups, respectively.

In multivariable Cox regression analysis, patients who underwent MMS showed more favourable local recurrence control (hazard ratio [HR], 0.42; 95 percent CI, 0.24–0.73; p=0.002), but a similar metastasis rate (HR, 1.38; 0.60–3.18; p=0.453) and tumour-related mortality (HR, 1.70; 0.59–4.93; p=0.329), compared with those who underwent WLE.

The beneficial effect of MMS, however, became nonsignificant for patients with pagetoid intraepithelial neoplasia (HR, 1.73; 0.37–8.21; p=0.488).

“Patients with pagetoid intraepithelial neoplasia may require adjuvant measures,” the authors said.

In this multicentre cohort study, the authors reviewed medical records for factors related to recurrence, metastasis and tumour-related mortality, and followed all eligible patients. Cox analyses, controlling for all confounders, was conducted to examine the impact of initial surgical modality on the prognoses.

The study was limited by its retrospective nature, according to the authors.

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