Yadlapati Sujitha, Rosa-Nieves Priscilla M, Mehta Nina, Merritt Bradley G, Carrasquillo Osward Y
HCA Corpus Christi Medical Center-Bay Area Dermatology Residency Program, McAllen, TX, USA.
School of Medicine, Ponce Health Sciences University, Ponce, Puerto Rico.
Int J Dermatol. 2024 Oct;63(10):1357-1362. doi: 10.1111/ijd.17283. Epub 2024 Jun 10.
Sebaceous carcinoma (SC) is a rare neoplasm affecting periocular and extraocular sites. If inadequately treated, it can recur and cause morbidity. Specific management guidelines have not been established. Wide local excision (WLE) has been traditionally used; however, Mohs micrographic surgery (MMS) can be advantageous because of complete margin assessment and tissue-sparing nature. This analysis aims to systematically review the surgical modalities used for the management of SC. Articles meeting eligibility criteria were identified using MEDLINE (via PubMed), Embase, Cochrane, and Scopus databases. All studies investigating surgical management of SC with WLE or MMS were considered. Seventy studies met inclusion criteria, including retrospective cohort studies, case series, and case reports. WLE was used in 32 studies, MMS in 29, and MMS and WLE in 9. Subgroup analysis showed that MMS has lower recurrence rates. For WLE, local, regional, and distant recurrence rates were 23.4%, 13.3%, and 11.0%, respectively, and for MMS, 6.8%, 4.3%, and 4.6%, respectively. Patients treated with WLE were more likely to have local recurrence than patients treated with MMS (P = 0.001). WLE cases were more likely to have a regional (P = 0.05) and distant recurrence (P = 0.001). Limitations of the study include heterogeneity of case reports, case series, and retrospective studies, variable follow-up times between the two groups, and large tumors included in the WLE category. In addition, disease-specific survival was not evaluated. MMS cases showed a superior outcome for local, regional, and distant recurrence, making it a good option for the management of SC.
皮脂腺癌（SC）是一种罕见的肿瘤，可累及眼周和眼外部位。若治疗不当，它可能复发并导致发病。目前尚未制定具体的管理指南。传统上采用广泛局部切除（WLE）；然而，莫氏显微外科手术（MMS）可能具有优势，因为它能进行完整的切缘评估且具有保留组织的特性。本分析旨在系统回顾用于治疗SC的手术方式。通过MEDLINE（经PubMed）、Embase、Cochrane和Scopus数据库识别符合纳入标准的文章。所有调查使用WLE或MMS治疗SC的手术管理的研究均被纳入考虑。70项研究符合纳入标准，包括回顾性队列研究、病例系列和病例报告。32项研究使用了WLE，29项使用了MMS，9项同时使用了MMS和WLE。亚组分析显示MMS的复发率较低。对于WLE，局部、区域和远处复发率分别为23.4%、13.3%和11.0%，而对于MMS，分别为6.8%、4.3%和4.6%。接受WLE治疗的患者比接受MMS治疗的患者更易发生局部复发（P = 0.001）。WLE病例更易发生区域复发（P = 0.05）和远处复发（P = 0.001）。本研究的局限性包括病例报告、病例系列和回顾性研究的异质性、两组之间不同的随访时间以及WLE类别中纳入的大肿瘤。此外，未评估疾病特异性生存率。MMS病例在局部、区域和远处复发方面显示出更好的结果，使其成为治疗SC的一个良好选择。
