Nationwide Trends in the Incidence and Survival of Eyelid Skin Cancers in Korea

Squamous cell carcinoma of the eyelid

Eyelid squamous cell carcinoma is a major type of rare eyelid cancer, together with basal cell carcinoma and sebaceous gland carcinoma. It is a painless disease that progresses slowly and is often detected by the appearance of nodules or plaques. Risk factors include exposure to ultraviolet light, fair skin, radiation and human papillomavirus infection. The standard treatment is surgical removal, and in cases of orbital invasion, orbital content removal is required. If sentinel node biopsy reveals a high risk of lymph node metastasis, adjuvant radiotherapy may be considered. Local chemotherapy, such as imiquimod and 5-fluorouracil, may be used for eyelid squamous cell carcinoma in situ. When surgery or radiotherapy is not recommended for distant metastases or locally advanced disease, drug therapy is often according to head and neck squamous cell carcinoma in Japan. The treatment often requires a multidisciplinary team to ensure the preservation of function and cosmetic appearance.

Periocular and ocular surface nonmelanoma skin cancer

Periocular and ocular surface nonmelanoma malignancies, including basal cell carcinoma (BCC), squamous cell carcinomas (SCC), and ocular surface squamous neoplasia (OSSN), are rare, but their management requires special considerations. The most common periocular malignancy is BCC, which constitutes 80% to 96% of tumors, followed by SCC, which represents 5% to 10% of tumors. OSSN represents a spectrum of diseases that encompass dysplastic alteration to the squamous epithelium of the eye. OSSN ranges from squamous dysplasia to conjunctival intraepithelial neoplasia/carcinoma in situ to invasive SCC, which is the most common ocular malignancy. These tumors can be staged using the eighth edition of the American Joint Committee on Cancer categorization system. The standard of care for periocular malignancies is Mohs micrographic surgery, while medical management with 5-fluorouracil (5-FU), interferon alfa-2b (INF), and mitomycin C (MMC) or "no touch" surgical excision are options for OSSN. Systemic therapies, including sonic hedgehog inhibitors for BCC and epidermal growth factor inhibitors and immune-checkpoint inhibitors for SCC, can be utilized for advanced disease. Recurrence rates are higher for periorbital and ocular malignancies than their respective cutaneous counterparts. These carcinomas and their respective treatments have unique side effects and considerations in an effort to preserve visual function.

A Retrospective Study of Ocular Cancer in Saudi Arabia: 25-Year Analysis

Background

Ocular malignancies are uncommon among eye diseases; however, they jeopardize both vision and life. The main objective of this study was to use to describe the epidemiology of eye and ocular adnexa malignancies across different ages and sex.

Methods

The King Khaled University institutional review board approved this study. Data on ocular cancer were retrieved from the Saudi Cancer Registry between 1994 and 2018. The registry collected important patient information such as demographic information (age, gender, and nationality), clinical details, and tumor classification.

Results

The total number of cases with ocular cancer diagnosed was 1051 cases. The highest number was recorded in Riyadh (35.39%, n=372), followed by Makkah (16.93%, n=178). The incidence was higher in the 0-4 years' age group (55.21%), and it got down as people got older. The data also revealed differences in the number of reported cases over time, as well as in the representation of eye cancer cases by gender and nationality. While many ocular cancer pathologies were seen, with "Retinoblastoma, not otherwise specified" being the most common (53.32%), the incidence rates for males and females remained largely stable over time.

Conclusion

The study emphasizes the need for continued monitoring, research, and analysis of potential of epidemiology of ocular cancer occurrence in Saudi Arabia. Identifying the geographical distribution and age pattern of Ocular malignancies have the potential to assist healthcare authorities and policymakers in developing precise strategies to reduce, recognize at an early stage, and successfully manage this condition.

A registration trend in eyelid skin cancers and associated risk factors in Iran, 2005-2016

BACKGROUND

Eyelid skin cancers are the most prevalent ophthalmic malignancies. This study aimed to evaluate the association of the Human Development Index (HDI) and lifestyle risk factors with eyelid skin cancers in Iran.

METHODS

This ecological study analyzed the data collected from the Iranian National Population-based Cancer Registry (2005-2016). The data on provincial-level eyelid skin cancer risk factors were obtained from national sources. The association between provincial HDI and lifestyle risk factors with the prevalence of eyelid skin cancers was assessed.

RESULTS

The mean 12-year age-standardized incidence rate (ASIR) of eyelid skin cancers was 16.22 per 100,000 (9,104 cases). The overall ASIR showed an upward trend with an estimated annual average increase of 0.006 per year. There were positive correlations between the prevalence of overall eyelid skin cancers and provincial HDI, smoking, and obesity (r = 0.32, 0.42, and 0.37, respectively). In multivariate analysis, obesity/overweight remained a positive predictor for high prevalence of total eyelid skin cancers (OR = 1.97, 95%CI = 1.08-3.58, P = 0.026), carcinoma (2.10, 1.15-3.83, P = 0.015), and basal cell carcinoma (1.48, 0.99-2.20, P = 0.054).

CONCLUSIONS

An increasing trend in ASIR of eyelid skin cancers was observed in more than a decade in Iran which was positively associated with provincial HDI and prevalence of obesity. The findings of the study highlight the importance of promotional programs for preventing obesity/overweight and appropriate allocation of screening facilities based on the HDI level.

Prevalence of human papillomavirus in eyelid carcinoma among Koreans: a clinicopathological study

BACKGROUND

Human papillomavirus (HPV) has been detected in eyelid sebaceous gland carcinoma (SGC) and squamous cell carcinoma (SCC), and detection rates greatly varied across studies. This study aimed to investigate the presence of HPV in eyelid SGC and SCC among Koreans and its correlation with clinicopathological characteristics.

METHODS

Surgically resected eyelid samples diagnosed as SGC or SCC from January 1999 to June 2011 were identified from the pathology database of three referral centres in Korea. Clinicopathological information including origin (skin vs. tarsal conjunctiva) and treatment outcomes were retrospectively reviewed. Immunohistochemistry (IHC) for p16, HPV DNA in situ hybridisation (ISH), and polymerase chain reaction-based DNA microarray were performed in paraffin-embedded tissue sections.

RESULTS

Our cohort included 34 SGC and 12 SCC cases with Asian ethnicity. HPV was detected in 4 SGC and 6 SCC by DNA microarray, while 2 SCC (16.7%) showed positivity in ISH. SCC of tarsal conjunctival origin was significantly more common in HPV-positive SCC than in HPV-negative SCC (5 of 6 vs. 0 of 6, P = 0.015, Fisher's exact test). Among samples showing positive staining in p16 IHC, HPV positivity rates were 0.0% (0/19) in SGC and 100% (3/3) in SCC. There was no significant difference in overall and local recurrence rate in eyelid SGC and SCC according to the HPV status (P > 0.99).

CONCLUSIONS

HPV was found in a subset of eyelid SGC and SCC among Koreans and might be aetiologically related to SCC of tarsal conjunctival origin. Overexpression of p16 is considered to be inappropriate as an indicator of HPV infection in eyelid SGC. Further investigation is required to elucidate the transmission route and pathogenic roles of HPV.

Long-term outcomes of margin-controlled excision for eyelid melanoma

OBJECTIVES

To provide evidence for long-term outcomes for margin-controlled excision of eyelid melanoma.

METHODS

Retrospective single-centre observational case series of patients treated for eyelid melanoma between 2007 and 2016, with a minimum of 5-year follow-up. Tumour excision involved rush-paraffin en face horizontal sections and delayed repair (Slow Mohs; SM).

RESULTS

Twenty-two cases were seen with a survival of 91% (two deaths from nodular and lentigo maligna melanoma) and seven with melanoma in situ (MIS). Invasive melanoma includes eight lentigo maligna melanoma, four nodular, two amelanotic and one desmoplastic. Mean Breslow thickness was 6 mm for invasive (range 0.5-26). Mean excision margin for MIS was 3 mm (range 2-5 mm) and for invasive was 5 mm (range 2-10). Further excisions were performed in nine (41%); two went on to recur. Local recurrence was 36%; six invasive (27%) at a mean of 24 months (range 1.5-5 years) and two for MIS at a mean of 15 months (range 1-1.5 years). Imaging occurred for suspected advanced disease. Sentinel node biopsy was not performed. Advanced melanoma therapy was performed in two cases. No vitamin D testing occurred.

CONCLUSIONS

Survival rates are in line with 90% overall survival in the UK. Prescriptive excision margins are not applicable in the periocular region and margin-controlled excision with a delayed repair is recommended, but patients need to know further excision may be needed to obtain clearance. Evidence recommending vitamin D therapy needs to be put into clinical practice. In addition, upstaging of MIS occurred advocating excision rather than observation of MIS. More studies are needed to determine the best management of eyelid melanoma.

Differentiating malignant and benign eyelid lesions using deep learning

Artificial intelligence as a screening tool for eyelid lesions will be helpful for early diagnosis of eyelid malignancies and proper decision-making. This study aimed to evaluate the performance of a deep learning model in differentiating eyelid lesions using clinical eyelid photographs in comparison with human ophthalmologists. We included 4954 photographs from 928 patients in this retrospective cross-sectional study. Images were classified into three categories: malignant lesion, benign lesion, and no lesion. Two pre-trained convolutional neural network (CNN) models, DenseNet-161 and EfficientNetV2-M architectures, were fine-tuned to classify images into three or two (malignant versus benign) categories. For a ternary classification, the mean diagnostic accuracies of the CNNs were 82.1% and 83.0% using DenseNet-161 and EfficientNetV2-M, respectively, which were inferior to those of the nine clinicians (87.0-89.5%). For the binary classification, the mean accuracies were 87.5% and 92.5% using DenseNet-161 and EfficientNetV2-M models, which was similar to that of the clinicians (85.8-90.0%). The mean AUC of the two CNN models was 0.908 and 0.950, respectively. Gradient-weighted class activation map successfully highlighted the eyelid tumors on clinical photographs. Deep learning models showed a promising performance in discriminating malignant versus benign eyelid lesions on clinical photographs, reaching the level of human observers.

Prevalence of and Associated Factors for Eyelid Cancer in the American Academy of Ophthalmology Intelligent Research in Sight Registry

PURPOSE

To estimate the prevalence of eyelid cancers in the American Academy of Ophthalmology Intelligent Research in Sight (IRIS) Registry and evaluate the associated factors.

DESIGN

Retrospective IRIS Registry database study.

PARTICIPANTS

All patients in the IRIS Registry between December 1, 2010, and December 1, 2018, with International Classification of Disease, ninth and 10th revisions, codes for eyelid cancers (basal cell carcinoma [BCC], squamous cell carcinoma [SCC], malignant melanoma [MM], sebaceous carcinoma/other specified malignant neoplasm [SBC], melanoma in situ [MIS], and unspecified malignant neoplasm [UMN]).

METHODS

The prevalence of each eyelid cancer type was estimated overall and by age group, sex, race, ethnicity, and smoking status. The associations between any eyelid cancer (AEC) or each cancer type and possible risk factors were examined using univariate and multivariate logistic regression models.

MAIN OUTCOME MEASURES

Prevalence of and associated factors for each eyelid cancer type.

RESULTS

There were 82 136 patients with eyelid cancer identified. The prevalence of AEC was 145.1 per 100 000 population. The cancer-specific prevalence ranged from 87.9 (BCC) to 25.6 (UMN), 11.1 (SCC), 5.0 (SBC), 4.1 (MM), and 0.4 (MIS) per 100 000 population. The prevalence of AEC and each cancer type increased with increasing age (all P < 0.0001), and the prevalence of AEC, BCC, SCC, and MM was higher in males (all P < 0.0001), MIS (P = 0.02). The prevalence of BCC, SCC, MM, SBC, and AEC was highest in Whites versus that in patients of any other race (all P < 0.0001). In the multivariate logistic regression model with associated risk factors (age, sex, race, ethnicity, and smoking status), AEC was associated with older age groups ([< 20 years reference {ref.}]; odds ratio [95% confidence interval]: 20-39 years: 3.35 [1.96-5.72]; 40-65 years: 24.21 [14.80-39.59]; and > 65 years: 42.78 [26.18-69.90]), male sex (female [ref.]; 1.40 [1.33-1.48]), White race (inverse associations with African Americans [0.12 {0.09-0.16}], Asians [0.19 {0.13-0.26}], others [0.59 {0.40-0.89}]), and ethnicity (non-Hispanic [ref.]; Hispanic: 0.38 [0.33-0.45]; unknown: 0.81 [0.75-0.88]). Active smoking (never smoker [ref.]) was associated with AEC (1.11 [1.01-1.21]), BCC (1.27 [1.23-1.31]), SCC (1.59 [1.46-1.73]), and MM (1.26 [1.08-1.46]).

CONCLUSIONS

This study reports the overall and cancer-specific prevalence of eyelid cancers using a large national clinical eye disease database. Smoking was found to be associated with AEC, BCC, SCC, and MM, which is a new observation. This epidemiologic profile of on-eyelid cancers is valuable for identifying patients at a higher risk of malignancy, allocating medical resources, and improving cancer care.

Sex Disparity for Patients with Cutaneous Squamous Cell Carcinoma of the Head and Neck: A Systematic Review

The incidence of head and neck cutaneous squamous cell carcinoma (HNcSCC) is unevenly distributed between men and women. At present, the mechanism behind this disparity remains elusive. This study conducted a systematic review and meta-analysis of proportions to investigate the disparity between sexes for patients with HNcSCC. PubMed, Scopus, EMBASE, MEDLINE, Emcare and CINAHL were searched in November 2021 and June 2022 (N > 50, English, human), and studies which examined the association between sex and HNcSCC were included. Analysis was conducted using RStudio with data and forest plots displaying males as a proportion of total patients with HNcSCC. Two independent researchers performed study selection, data extraction, data analysis and risk of bias. Eighty-two studies (1948 to 2018) comprising approximately 186,000 participants (67% male, 33% female) from 29 countries were included. Significantly more males had HNcSCC overall (71%; CI: 67−74). Males were also significantly more affected by cSCC of the ear (92%; CI: 89−94), lip (74%; CI: 66−81), and eyelid (56%; CI: 51−62). This study found HNcSCC disproportionately affected males overall and across all subtypes. Improving our understanding of sex-specific mechanisms in HNcSCC will better inform our preventive, therapeutic and prognostic practices.

The epidemiology of adults' eyelid malignancies in Germany between 2009 and 2015; An analysis of 42,710 patients' data

PURPOSE

We report the incidence of malignant tumors of the eyelid in Germany between 2009 and 2015.

METHODS

Data pertaining to the period between 2009 and 2015 were extracted from the German Cancer Registry. The International Classification of Diseases for Oncology-3 codes for tumors of the eyelid or canthus were used to identify incidence rates and survival probabilities. Crude and age-standardized incidence rates (ASR) were calculated by age, year, and gender and the individual federated states. Survival was calculated using the Kaplan-Meyer and Life tables methods, and COX-Regression was used to calculate hazard ratios for overall and cancer-specific survival.

RESULTS

This study examined data pertaining to 42,710 patients who had been diagnosed with malignant tumors of the eyelid. Basal cell carcinoma was by far the most common tumor of the eyelid (87.1%), followed by squamous cell carcinoma (10.1%) and malignant melanoma (1.1%). ASRs of basal cell carcinoma, squamous cell carcinoma, and melanoma were 65.1, 7.49, and 0.83 per million, respectively. Sebaceous cell carcinoma did not appear to be of high prevalence in Germany. Cancer-specific survival was generally high, exceeding 95%. The overall survival of patients with melanoma was considerably lower than those with other cancers. Both survival rates were inferior to that of basal cell carcinoma (74.9%). Cancer-Specific survival at five years for all groups exceeded 95%.

CONCLUSIONS

The incidence rates of malignant lid tumors match that of the European countries but shows a different pattern than Asian countries.

Clinicopathologic Characteristics and Prognostic Factors Impacting Survival in Melanoma of the Eyelid

PURPOSE

To examine prognostic factors for survival in patients with melanoma of the eyelid.

DESIGN

Retrospective cohort study.

METHODS

This population-based study reviewed patients with primary melanoma of the eyelid diagnosed in the Surveillance, Epidemiology and End Results database between 1975 and 2016. The primary outcomes included survival rates estimated by Kaplan-Meier analysis and mortality hazard ratios (HRs) for overall survival and disease-specific survival (DSS).

RESULTS

The cohort consisted of 2257 patients with cutaneous melanoma of the eyelid, representing 1380 cases of melanoma in situ and 877 cases of invasive melanoma. For melanoma in situ and invasive melanoma respectively, at 5 years, the overall survival rates were 88.6% and 77.1%, while DSS rates were 99.4% and 91.0%. Cox regression analysis for eyelid melanoma indicated that for invasive melanoma, age at diagnosis ≥75 years (HR 2.17 [95% confidence interval {CI} 1.02-4.60]; P = .04), T4 staging (HR 8.45 [95% CI 2.96-25.31]; P < .001), lymph node involvement (HR 3.61 [95% CI 1.12-11.60]; P = .03), and nodular melanoma (HR 3.31 [95% CI 1.50-7.32]; P = .003) histologic subtype were associated with decreased rates of survival. Sex and tumor ulceration did not impact survival.

CONCLUSIONS

This study is the largest analysis to date that focuses on DSS for cutaneous melanoma of the eyelid. The most significant predictors for invasive melanoma survival are age ≥75 years at diagnosis, T4 staging, lymph node involvement, and the nodular melanoma histologic subtype. Patients with these attributes are at higher risk and should be counseled regarding prognosis.