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 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 controlling all confounders.

RESULTS: Among 360 patients included in this cohort, 115 (31.9%) of them underwent MMS as primary resection, whereas 245 (68.1%) cases underwent WLE. After a median follow-up period of 60.0 months, local recurrence was observed in 18 (15.7%) patients of the MMS group and 97 (39.6%) patients of the WLE group. Metastasis occurred in 9 (7.8%) patients who underwent MMS and 38 (15.5%) who underwent WLE. Six (5.2%) patients in the MMS group and 21 (8.6%) in the WLE group died of metastatic SC. Multivariable Cox regression indicated that, compared with the WLE group, the MMS group exhibited more favorable local recurrence control (HR=0.42; 95%CI:0.24-0.73; p=0.002), but a comparable metastasis rate (HR=1.38; 95%CI:0.60-3.18; p=0.453) and tumor-related mortality (HR=1.70; 95%CI:0.59-4.93; p=0.329). However, this beneficial effect became nonremarkable for patients with pagetoid intraepithelial neoplasia (HR=1.73; 95%CI:0.37-8.21; p=0.488).

LIMITATIONS: Retrospective nature.

CONCLUSION: MMS should be proposed for eyelid SC without orbital involvement to achieve recurrence control, however, this surgery did not change the long-term outcomes in terms of metastasis and tumor-related mortality. Patients with pagetoid intraepithelial neoplasia may require adjuvant measures.