Orbital Oncology and Ophthalmic Plastic Surgery, Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, U.S.A.
Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Ophthalmic Plast Reconstr Surg. 2019 Sep/Oct;35(5):419-425. doi: 10.1097/IOP.0000000000001343.
To identify clinicopathologic factors associated with local recurrence of eyelid sebaceous carcinoma and determine whether routine conjunctival map biopsies are necessary to detect pagetoid spread.
The authors searched PubMed for articles on eyelid sebaceous carcinoma and pagetoid spread published in English during 1982 to 2018, and they reviewed 99 consecutive patients with eyelid sebaceous carcinoma who underwent surgical excision with frozen section control of margins performed by 1 author (BE) during 1999 to 2017.
Local recurrence rates after surgery were 5% to 25% in the literature and 6% in the authors' cohort. Risk factors for local recurrence included T3b (>20 mm) or worse disease according to the AJCC Cancer Staging Manual, eighth edition, pagetoid spread, diffuse growth pattern, and multicentric origin. Pagetoid spread was observed in 8.3% to 70% of patients in the literature and 31% of patients in the authors' cohort. The literature review showed that surgical excision with frozen section control is the mainstay of management of eyelid sebaceous carcinoma, with topical chemotherapy and cryotherapy used in cases with pagetoid spread. The authors found no solid evidence for added value from routine 4-quadrant conjunctival map biopsies, and some studies called into question their accuracy and yield.
In patients with eyelid sebaceous carcinoma, meticulous microscopic margin control is appropriate in all cases and particularly for tumors >20 mm and adjuvant topical chemotherapy should be considered for tumors with conjunctival pagetoid spread. Routine conjunctival map biopsies are not essential, but targeted map biopsies of areas with signs suggestive of pagetoid intraepithelial spread may be appropriate to guide future closer observation or adjuvant treatments.
确定与眼睑皮脂腺癌局部复发相关的临床病理因素，并确定常规结膜地图活检是否有必要检测 paget 样播散。
作者在 PubMed 上搜索了 1982 年至 2018 年期间以英文发表的关于眼睑皮脂腺癌和 paget 样播散的文章，并回顾了 1999 年至 2017 年期间由 1 位作者（BE）进行的 99 例连续眼睑皮脂腺癌手术切除患者的资料，这些患者均进行了冰冻切片控制切缘。
文献报道的手术后局部复发率为 5%至 25%，作者队列中的复发率为 6%。局部复发的危险因素包括 AJCC 癌症分期手册第八版中的 T3b（>20mm）或更严重的疾病、paget 样播散、弥漫性生长模式和多中心起源。文献报道的 paget 样播散发生率为 8.3%至 70%，作者队列中的发生率为 31%。文献复习表明，手术切除加冰冻切片控制是眼睑皮脂腺癌的主要治疗方法，对于有 paget 样播散的病例使用局部化疗和冷冻治疗。作者没有发现常规 4 象限结膜地图活检有附加价值的可靠证据，一些研究对其准确性和效果提出了质疑。
在眼睑皮脂腺癌患者中，所有病例均应进行仔细的显微镜下切缘控制，特别是对于>20mm 的肿瘤，对于结膜有 paget 样播散的肿瘤应考虑辅助局部化疗。常规结膜地图活检不是必需的，但对于有 paget 样上皮内播散迹象的区域进行靶向地图活检可能有助于指导未来更密切的观察或辅助治疗。
