'Fast-tracking' cancer referrals: application for periocular basal cell carcinoma

Statistical evaluation and positive predictive value of key features of periorbital basal cell carcinoma

OBJECTIVE

To determine the accuracy of using the suspicious features of periorbital lesions-telangiectasias, madarosis, and ulceration-to identify basal cell carcinoma (BCC). This may impact whether a histopathologic confirmation is always necessary.

METHODS

This retrospective review of patients who underwent biopsy of eyelid lesions was conducted over a five-year period, between 2015 and 2020 at a single clinical site. Specifically, the histopathologic diagnosis and the presence or absence of clinical signs of madarosis, ulceration and telangiectasia were recorded. The positive predictive value (PPV) for eyelid BCC and odds ratio of each of these clinical signs was calculated.

RESULTS

179 patients underwent incisional biopsies of eye lid lesions. Of the 79 patients with eyelid BCC, 96% had ulceration, 95% had madarosis, and 75% had telangiectasias over the lid lesion; this contrasted with the 3%, 4% and 6% respectively in the 100 patients with benign lid lesions. The PPV for eyelid BCC of ulceration was 95.0%, madarosis was 96.2% and telangiectasias was 90.8%. The presence of two or all three signs in a patient was strongly predictive of BCC (PPV=100%).

CONCLUSION

The presence of two or more suspicious features almost ensures the accuracy of the suspected diagnosis of a BCC. This suggests that biopsy of eyelid lesions before complete surgical excision that demonstrate several defining features may not be necessary in all cases. However, lesions that do not demonstrate multiple explicit features that indicate a malignancy will still require histopathologic confirmation.