Practice patterns in the management of sebaceous cell carcinoma of the eyelid in Asia Pacific region

Abstract

Purpose: To determine the practice patterns of ophthalmic plastic surgeons regarding the management of eyelid sebaceous gland carcinoma (SGC). Methods: An electronic survey was distributed to members in the Asia Pacific region requesting their demographic information and treatment approaches to SGC. Results: 192 respondents completed the survey, with 95.3% respondents from the Asia Pacific region. For initial diagnosis, most surgeons selected incisional biopsy (54.8%), followed by full thickness excisional biopsy (34.8%). Initial workup is mainly by physical examination, palpation of lymph nodes and radiological imaging. Conjunctival map biopsy is done in selective cases. Sentinel lymph node biopsy (SLNB) is done mainly for tumours larger than 10mm. Management is mainly by surgical excision (5mm margin) combined with adjuvant, with Mitomycin-C being the most common. Margin involvement is determined by frozen section by pathologist (57.2%) followed by Moh’s micrographic surgery (18.1%). Surveillance is mainly with physical examination alone. Conclusions: SGC is not uncommon in Asian population, this survey reported herein found that Asia Pacific oculoplastic surgeons prefer incisional biopsy for lesions suspicious of SGC. This may be related to more nodular lid mass presentation in this population. This is in contrast to survey results from British cohort. Conjunctival map biopsy is more commonly performed even though pagetoid spread is more commonly seen in Caucasian population. In addition, despite Moh’s micrographic surgery and SLNB may have survival benefits, access to these expertise may be limited and therefore not widely used.