Treatment options and future prospects for the management of eyelid malignancies - An evidence-based update

Purpose: To provide evidence-based clinical recommendations for treatment o ptions and future, prospects for the management of common malignant eyelid tumors, including global ratings for the strength of published, evidence su pporting them, Clinical Relevance. Approximately 5% to 10% of all skin cancers occur in th e eyelid. Incidence studies indicate that basal cell carcinoma is the most frequent malignant eyelid tumor, followed by squamous cell carcinoma, sebac eous gland carcinoma, and malignant melanoma. Many therapeutic methods have been suggested to combat the morbidity and mortality associated with these lesions. Literature Reviewed: A MEDLINE and PubMed literature search (1966-1999) was conducted for English language abstracts and appropriate (selected) full-t ext references retrieved regarding treatment of malignant eyelid tumors. Th ese sources then were used to prepare recommendations for patient care. Eac h recommendation was rated according to: (1) its importance in the care pro cess and (2) the strength of evidence supporting the given recommendation. Results: All recommendations were rated as level A (very important to patie nt-care outcome). For basal cell; carcinoma, squamous cell carcinoma, and s ebaceous gland carcinoma, the published evidence supporting two recommendat ions (Mohs' micrographic surgery or excision with frozen-section control) w ere graded as I (providing strong evidence in support of a recommendation). For sebaceous gland carcinoma, the recommendations also included conjuncti val map biopsies. The published evidence supporting all other recommendatio ns for these three eyelid tumors were graded II (substantial evidence in su pport of a recommendation), primarily because of the small numbers of patie nts in each clinical study. For malignant melanoma, the recommendation for therapy (i.e., excision with variable margins depending on tumor thickness) was based on published papers individually variably rated as I, II, and II I, reflecting ongoing debate as to the best method of therapy. Conclusions: Published reports regarding the treatment of malignant eyelid tumors include a myriad of treatment options. The strongest evidence favors complete surgical removal using histologic controls for verifying tumor-fr ee margins of excision. Ophthalmology 2001;108.2088-2100 (C) 2001 by the Am erican Academy of Ophthalmology.