Dr. Gupta Roshmi, G08406, Dr. Vikas Menon, Dr. Sima Das, Dr. Bhaduri Anirban
Introduction
The common eyelid malignancies include basal cell carcinoma, sebaceous carcinoma and squamous cell carcinoma. Although basal cell carcinoma is held to be the commonest eyelid malignancy in Western literature, sebaceous carcinoma is known to have the worst prognosis among eyelid malignancies, with 16% orbital extension and 24% loco-regional recurrence. (1)
The Indian literature on eyelid malignancies include series from apex referral centre, pathology service and plastic surgery practice of specific regions of India.(2-6) There is no pan-Indian data available. Neither is there any reporting of AJCC classification of eyelid malignancies in India.
Aim:
The study aimed to analyse pan-Indian data on eyelid malignancy.
Methods:
The study was a collaborative multicentre study, from four geographic zones in India. All the participating ophthalmologists were trained in principles of oculoplastic surgery and ocular oncology, and have been practising exclusive sub-speciality oculoplasty. A common data collection form was designed, which included clinical features, pathology, AJCC class, travel distance from patient’s home to the clinic, treatment , both planned and performed, and outcome were analysed. Since some of the data dated from earlier, the AJCC 7th edition classification was applied retrospective based on the recorded extent and sizeOnly patients with biopsy proven malignancy were included in the study.
Results:
The final analysis included total 108 patients, 53% female. Mean age of patients was 64 years. From first appearance of signs, the mean delay to first consultation 18.7 months. The mean distance from home to hospital was 134 km.
Pathology included 46/108 (43%)sebaceous (SGC), 42/108 (39%)basal cell carcinoma (BCC); other entities included rest squamous cell carcinoma, eccrine carcinoma and lymphoma. Commonest AJCC classes were T2b and T3a, accounting for 74/108 lesions(69%). Orbital invasion was seen in 10/108 (9.25%), pagetoid spread was found in 13 (28% of SGC). Surgery with free margin was done in 97 eyes, with other patients lost to follow-up after surgical advice. Mean follow-up was 9.9 months, with metastasis and/or recurrence in 6 eyes. All the recurrences were SGC or SCC, commonly seen was 12% recurrence of SGC in spite of histopathologic margin clearance.There was no difference between metro(37%) and non-metro (63%) patients in mean delay of first consult or mean follow-up .
Discussion
Worldwide the commonest eyelid malignancy has been seen to be basal cell carcinoma. (6-8) A study from Iran found 80% of eyelid malignancy to be basal cell carcinoma.(8)
A study from Pakistan found basal cell carcinoma to be the commonest malignancy.(7) Studies from Hong Kong in patients of Chinese origin showed basal cell carcinoma to be the commonest in eyelid malignancies (43%- 75%).(8,9) A study from Japan put the proportions of basal cell carcinoma and sebaceous carcinoma to be near equal. (10) A study from Singapore cancer registry showed basal cell carcinoma to be present in 80% of eyelid malignancy patients.(11)
It has long been the impression that the pattern of eyelid malignancies in India differs from that in the Western population. However the reports have been variable . The results showed equal prevalence of basal cell, squamous cell and sebaceous carcinoma in a study from north India (2). Another north Indian study found basal cell carcinoma to be the commonest malignancy in Indian population.(3) A plastic surgery practice in central India found basal cell carcinoma (48%) to be the commonest eyelid malignancy.(4,5)Another study from north India put basal cell carcinoma at 38% and sebaceous carcinoma at 27%.(6)
However, due to the vast geographical expanse of India, and lack of any uniform reporting, it would be difficult to generalise about eyelid malignancy patterns in India from these reports. Specific referral centres are also likely to have referral bias.
Although AJCC classification is important in predicting outcomes of eyelid malignancies,(13) the India studies date from earlier, and do not report any AJCC classification. The current study collates data from the four major regions of India (north, east, west and south), both urban and rural data, and includes AJCC classification. Thus the study attempts to fill the need for information in India, with representative data and avoiding bias.
Our data showed equal numbers of sebaceous and basal cell carcinoma.Sebaceous carcinoma is an aggressive tumor, with studies reporting 24% local recurrence after surgical management (2), 53% loco-regional recurrence even after orbital exenteration.(13)In our data , nearly 10% of eyelid malignancies required orbital exenteration. Of these, 6 were sebaceous carcinoma, 3 basal cell carcinoma and one adenosquamous carcinoma. Of our patients, 12% of the sebaceous carcinomas showed locoregional recurrence.
Conclusion
The collaborative Indian data shows highest prevalence of SGC and BCC. Sebaceous carcinoma is likely to present with more advanced disease. Even with protocol based management, SGCshowed 12% locoregional recurrence.
However an encouraging sign is that patients from rural areas surrounding the higher medical centres are as likely to seek timely management as their urban counterparts. With commonest AJCC class T2b or T3a, most tumors are locally resectable.
Reference:
1.Kaliki S, Ayyar A, Dave TV, Ali MJ, Mishra DK, Naik MN. Sebaceous gland carcinoma of the eyelid: clinicopathological features and outcome in Asian Indians.Eye (Lond). 2015 Jul;29(7):958-63.
2.Sihota R, Tandon K, Betharia SM, Arora R. Malignant eyelid tumors in an Indian population.Arch Ophthalmol, 114 (1), 108-9.
3.Abdi U, Tyagi N, Maheshwari V, Gogi R, Tyagi SP. Tumours of eyelid: a clinicopathologic study. J Indian Med Assoc. 1996 Nov;94(11):405-9, 416, 418.
4.Kale SM, Patil SB, Khare N, Math M, Jain A, Jaiswal S. Clinicopathological analysis of eyelid malignancies – A review of 85 cases. Indian J Plast Surg. 2012 Jan;45(1):22-8.
5.Jahagirdar SS, Thakre TP, Kale SM, Kulkarni H, Mamtani M. A clinicopathological study of eyelid malignancies from central India.Indian J Ophthalmol. 2007 Mar-Apr;55(2):109-12.
6. Bagheri A, Tavakoli M, Kanaani A, Zavareh RB, Esfandiari H, Aletaha M, SalourH. Eyelid masses: a 10-year survey from a tertiary eye hospital in Tehran.Middle EastAfr J Ophthalmol. 2013 Jul-Sep;20(3):187-927.
7.Hussain I, Khan FM, Alam M, Khan BS. Clinicopathological analysis of malignant eyelid tumours in north-west Pakistan.J Pak Med Assoc. 2013 Jan;63(1):25-7.8.
8.Ho M, Liu DT, Chong KK, Ng HK, Lam DS. Eyelid tumours and pseudotumours in Hong Kong: a ten-year experience.Hong Kong Med J. 2013 Apr;19(2):150-5.9.
9.Mak ST, Wong AC, Io IY, TseRK.Malignant eyelid tumors in Hong Kong 1997-2009.Jpn J Ophthalmol. 2011 Nov;55(6):681-5.
10.Takamura H, Yamashita H.Clinicopathological analysis of malignant eyelid tumor cases at Yamagata university hospital: statistical comparison of tumor incidence in Japan and inother countries. Jpn J Ophthalmol. 2005 Sep-Oct;49(5):349-54.
11. Lim VS, Amrith S. Declining incidence of eyelid cancers in Singapore over 13 years:population-based data from 1996 to 2008.Br J Ophthalmol. 2012 Dec;96(12):1462-5.
12.Deo SV, Shukla NK, Singh M, Jha D, Khanna P, Kallianpur A. Locally advanced sebaceous cell carcinoma (T3) of eyelid: incidence and pattern of nodal metastases and combined modality management approach. Orbit. 2012 Jun;31(3):150-4.
13.Darryl J. Ainbinder, BitaEsmaeli, Stephen C. Groo, Paul T. Finger, Joseph P. Brooks. Introduction of the 7th Edition Eyelid Carcinoma Classification System From the American Joint Committee on Cancer–International Union Against Cancer Staging Manual. Arch Pathol Lab Med—Vol 133, August 2009.
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