AUSTIN, TEX. A chart review aimed at quantifying the incidence and type of periocular skin cancers showed that the vast majority were basal cell carcinomas, and that there was a slight predominance of the cancers in men.
The study was undertaken partly because there has been an increase in eyelid malignancies, which is thought to be due to a lack of protection from ultraviolet radiation, Dr. Jens Thiele said at the annual meeting of the American College of Mohs Surgery.
This is the largest U.S.-based study of periocular cancers ever conducted, said Dr. Thiele, a dermatologist in private practice in Birmingham, Ala.
He and his colleagues reviewed charts at a single center from 553 consecutive Mohs surgery patients from January 2005 to September 2008.
All of the patients were white (Fitzpatrick skin types I, II, and III). There were 346 men and 207 women. Interestingly, 61% of the tumors were in men.
Of the tumors, there were 435 basal cell carcinomas (BCCs), 105 squamous cell carcinomas (SCCs), 10 melanomas, and one of each of the following: sebaceous carcinoma, trichoepithelioma, and dermatofibrosarcoma protuberans.
The investigators also quantified location and pre- and postoperative defect sizes. Most often, BCCs were located on the lower eyelid (246, or 57%). They were also found on the medial canthus (28%), upper eyelid (10%), and lateral canthus (6%).
Squamous cell tumors also were found most frequently on the lower eyelid (64 or 61%), followed by the medial canthus (17%), the upper eyelid (15%), and the lateral canthus (7%), Dr. Thiele reported.
Six of the 10 melanomas were also on the lower eyelid; 8 of the tumors were in females.
For BCCs, the pre- and postoperative sizes were smallest on the upper eyelids, while the largest tumors were found on the medial canthus. The mean number of Mohs layers needed for BCC clearance ranged from 1.33 in the lateral canthus to 1.42 in the medial canthus.
SCCs had larger pre-op and postop sizes, but the number of layers needed for clearance was lower. The mean number for SCC clearance was 1.5 in the medial canthus and 1.1 in the lateral canthus, Dr. Thiele said.
Although this study confirmed the results of some large Australian databases, the chart review found a two fold higher occurrence of SCCs on the upper eyelid than had been reported previously, he noted.
Better knowledge of high-risk histologies and locations of periocular skin cancers should assist surgeons, said Dr. Thiele, who reported no conflicts.