Comparison of the Clinical Characteristics and Outcome of Benign and Malignant Eyelid Tumors: An Analysis of 4521 Eyelid Tumors in a Tertiary Medical Center

Updates on eyelid cancers

In this review, we aim to provide an overview of the five most common malignant eyelid tumors with current treatment recommendations based on international guidelines. Particular attention is paid to the clinicopathological correlation and the update with regard to adequate treatment. Newer systemic therapies enrich the existing treatment options, of which complete tumor excision remains the most important therapeutic measure.

HM_ADET: a hybrid model for automatic detection of eyelid tumors based on photographic images

BACKGROUND

The accurate detection of eyelid tumors is essential for effective treatment, but it can be challenging due to small and unevenly distributed lesions surrounded by irrelevant noise. Moreover, early symptoms of eyelid tumors are atypical, and some categories of eyelid tumors exhibit similar color and texture features, making it difficult to distinguish between benign and malignant eyelid tumors, particularly for ophthalmologists with limited clinical experience.

METHODS

We propose a hybrid model, HM_ADET, for automatic detection of eyelid tumors, including YOLOv7_CNFG to locate eyelid tumors and vision transformer (ViT) to classify benign and malignant eyelid tumors. First, the ConvNeXt module with an inverted bottleneck layer in the backbone of YOLOv7_CNFG is employed to prevent information loss of small eyelid tumors. Then, the flexible rectified linear unit (FReLU) is applied to capture multi-scale features such as texture, edge, and shape, thereby improving the localization accuracy of eyelid tumors. In addition, considering the geometric center and area difference between the predicted box (PB) and the ground truth box (GT), the GIoU_loss was utilized to handle cases of eyelid tumors with varying shapes and irregular boundaries. Finally, the multi-head attention (MHA) module is applied in ViT to extract discriminative features of eyelid tumors for benign and malignant classification.

RESULTS

Experimental results demonstrate that the HM_ADET model achieves excellent performance in the detection of eyelid tumors. In specific, YOLOv7_CNFG outperforms YOLOv7, with AP increasing from 0.763 to 0.893 on the internal test set and from 0.647 to 0.765 on the external test set. ViT achieves AUCs of 0.945 (95% CI 0.894-0.981) and 0.915 (95% CI 0.860-0.955) for the classification of benign and malignant tumors on the internal and external test sets, respectively.

CONCLUSIONS

Our study provides a promising strategy for the automatic diagnosis of eyelid tumors, which could potentially improve patient outcomes and reduce healthcare costs.

Clinical features and management of eyelid margin nevi

PURPOSE

Acquired melanocytic nevi are common eyelid lesions; however, their clinical presentation is not well documented.

METHODS

In this retrospective study, clinical records were reviewed in patients evaluated between 2005 and 2022.

RESULTS

Eyelid margin nevi (n = 150) were more commonly excised in female (78%) and Caucasian (86%) patients. Change in appearance/size were frequent presenting complaints, and 17% experienced ocular symptoms. Referring diagnosis included other benign lesions (11.3%), and concern for malignancy (16.7%). Many individuals (38.7%) noted their lesion for ≤5 years. Nevi were distributed across the 4 margins (9% peripunctal), and 88% had a regular base. Visible pigmentation was more common in non-Caucasians (95.2%) than Caucasians (41.1%). Lashes grew through 60.7% of nevi and were often misdirected.Nevi were treated with superficial excision and cauterization. Histologic subtypes included: dermal (86.6%), compound (9.4%), blue (2.7%), junctional (0.7%), lentiginous dysplastic (0.7%). An irregular base (p=0.042) and pigmentation (p=0.056) were more common in compound than dermal nevi. Lash line quality and appearance were improved in the majority of patients returning for follow-up, although postoperative trichiasis, marginal erythema, and residual pigmentation were observed.

CONCLUSIONS

Melanocytic nevi commonly involve the eyelid margins and have a variety of presentations and appearances. Existing nevi can change, and new lesions appear throughout adulthood. Stable, benign appearing nevi can be observed. Shave excision provides a diagnosis and improved appearance for symptomatic or suspicious lesions, with few serious complications. Malignant transformation is rare, although evidence for recurrence warrants further evaluation.

Comparison of the clinical characteristics of benign and malignant eyelid lesions: an analysis of 1423 eyelid lesions, compared between ophthalmology department and plastics department

PURPOSE

Oculoplastic surgeons excise and reconstruct eyelid tumors, although plastic surgeons have traditionally managed these cases. Current demand of this surgery is growing, and planning referral services is a health management necessity. This pilot study retrospectively reviewed same population eyelid specimens excised by both disciplines comparing data.

METHODS

Clinical and epidemiologic features of 1423 eyelid lesions biopsied between 2015- 2020 in Emek Medical Center (EMC), Israel were reviewed.

RESULTS

Among 1423 specimens, 1210 (85.0%) were benign and 213 (15.0%) were malignant/pre-malignant. Mean age at diagnosis was significantly higher in malignant tumors than in benign tumors (76 and 59 years respectively, p value < 0.001). The most common benign eyelid lesions were soft fibroma (20.1%), seborrheic keratosis (11.0%) and melanocytic nevus (10.3%). The most common malignant/pre-malignant eyelid tumors were basal cell carcinoma (BCC) (9.2%), actinic keratosis (2.6%) and Bowen's disease (1.9%). Ophthalmology removed 37 malignant/pre-malignant lesions (5.4%) out of 683 compared to plastics removing 142 malignant/pre-malignant lesions out of 740 (19.2%) specimens. Eyelid malignancy in the plastics department was significantly higher than in the ophthalmology department (p value < 0.001). 270 (70.0%) lesions caused by UV exposure were removed by plastics and 116 (30.0%) were removed by ophthalmology (p value < 0.001).

CONCLUSIONS

Eyelid lesions in patients aged 76 or older are more likely to be malignant. Ophthalmology eyelid specimens in younger patients are more commonly benign and related to inflammation. Specimens from the plastics department are more commonly malignant, related to UV-exposure, and are from older patients. This difference may be due to a misconception that plastic surgeons have more eyelid cancer reconstruction experience than oculoplastic surgeons, or less awareness of the oculoplastic expertise available today.

Base-Excision Repair Mutational Signature in Two Sebaceous Carcinomas of the Eyelid

Personalized medicine aims to develop tailored treatments for individual patients based on specific mutations present in the affected organ. This approach has proven paramount in cancer treatment, as each tumor carries distinct driver mutations that respond to targeted drugs and, in some cases, may confer resistance to other therapies. Particularly for rare conditions, personalized medicine has the potential to revolutionize treatment strategies. Rare cancers often lack extensive datasets of molecular and pathological information, large-scale trials for novel therapies, and established treatment guidelines. Consequently, surgery is frequently the only viable option for many rare tumors, when feasible, as traditional multimodal approaches employed for more common cancers often play a limited role. Sebaceous carcinoma of the eyelid is an exceptionally rare cancer affecting the eye's adnexal tissues, most frequently reported in Asia, but whose prevalence is significantly increasing even in Europe and the US. The sole established curative treatment is surgical excision, which can lead to significant disfigurement. In cases of metastatic sebaceous carcinoma, validated drug options are currently lacking. In this project, we set out to characterize the mutational landscape of two sebaceous carcinomas of the eyelid following surgical excision. Utilizing available bioinformatics tools, we demonstrated our ability to identify common features promptly and accurately in both tumors. These features included a Base-Excision Repair mutational signature, a notably high tumor mutational burden, and key driver mutations in somatic tissues. These findings had not been previously reported in similar studies. This report underscores how, in the case of rare tumors, it is possible to comprehensively characterize the mutational landscape of each individual case, potentially opening doors to targeted therapeutic options.

Guidelines for the application of artificial intelligence in the diagnosis of anterior segment diseases (2023)

The landscape of ophthalmology has observed monumental shifts with the advent of artificial intelligence (AI) technologies. This article is devoted to elaborating on the nuanced application of AI in the diagnostic realm of anterior segment eye diseases, an area ripe with potential yet complex in its imaging characteristics. Historically, AI's entrenchment in ophthalmology was predominantly rooted in the posterior segment. However, the evolution of machine learning paradigms, particularly with the advent of deep learning methodologies, has reframed the focus. When combined with the exponential surge in available electronic image data pertaining to the anterior segment, AI's role in diagnosing corneal, conjunctival, lens, and eyelid pathologies has been solidified and has emerged from the realm of theoretical to practical. In light of this transformative potential, collaborations between the Ophthalmic Imaging and Intelligent Medicine Subcommittee of the China Medical Education Association and the Ophthalmology Committee of the International Translational Medicine Association have been instrumental. These eminent bodies mobilized a consortium of experts to dissect and assimilate advancements from both national and international quarters. Their mandate was not limited to AI's application in anterior segment pathologies like the cornea, conjunctiva, lens, and eyelids, but also ventured into deciphering the existing impediments and envisioning future trajectories. After iterative deliberations, the consensus synthesized herein serves as a touchstone, assisting ophthalmologists in optimally integrating AI into their diagnostic decisions and bolstering clinical research. Through this guideline, we aspire to offer a comprehensive framework, ensuring that clinical decisions are not merely informed but transformed by AI. By building upon existing literature yet maintaining the highest standards of originality, this document stands as a testament to both innovation and academic integrity, in line with the ethos of renowned journals such as Ophthalmology.

[Differential diagnoses of benign eyelid tumors in children and adolescents]

BACKGROUND

The clinical diagnosis as well as the treatment approach of periocular tumors in childhood and adolescence can be challenging. Knowledge of the most important differential diagnoses and their clinicopathological correlation is helpful for the treatment approach.

OBJECTIVE

The clinical and histological characteristics of various eyelid tumors in childhood and adolescence are presented taking the excision frequencies into consideration.

MATERIAL AND METHODS

The frequencies and clinicopathologic correlation of the most important eyelid tumors (n = 485) are presented based on the data of the ophthalmopathology laboratory of the University Eye Hospital Bonn from 1998-2023.

RESULTS

The most frequent tumor in childhood and adolescence is chalazion (57.3%), followed by dermoid cysts (16.7%) and molluscum contagiosum (9.6%). Other lesions of childhood and adolescence include pilomatrixoma (2.1%), hemangioma and other vascular malformations (4.7%) and rare differential diagnoses, such as subcutaneous calcifying nodules and xanthogranuloma. Guidance on the approach in different age groups is presented in the form of a decision tree.

CONCLUSION

Tumors in children and adolescents are mostly benign, yet there are important indications for excision. A histological examination of any excised tissue in childhood and adolescence is obligatory because unexpected findings are not uncommon and the spectrum of lesions also differs from that in adulthood. Knowledge of the histological picture can be very helpful in the preoperative clinical classification and for planning further procedures.

Clinicopathological analysis of eyelid lesions in Sri Lanka

PURPOSE

We intended to review the clinical features and histological findings of eyelid lesions in Sri Lanka.

METHODS

We conducted a descriptive cross-sectional study to analyse clinicopathological characteristics of eyelid lesions from 2013 to 2017 in the National Eye Hospital of Sri Lanka.

RESULTS

The age of patients ranged from 3 months to 83 years (mean = 46 ± 21 years). The male-to-female ratio in the sample was 1:1.3. Among 654 histologically confirmed eyelid lesions, the majority (n = 407/654, 62%) were neoplastic lesions including 322 benign, 11 premalignant and 74 malignant neoplasms. The commonest benign tumour was seborrheic keratosis (n = 98), and the commonest non-neoplastic lesion was pyogenic granuloma (n = 64). Seventy-four patients had malignant neoplasia including 24 sebaceous carcinoma, 18 basal cell carcinoma, and 14 squamous cell carcinoma. The most common site of malignant lesions was the upper eyelid. The mean age of patients with malignant eyelid lesions was 64 ± 13 years.

CONCLUSIONS

Neoplastic lesions outnumbered nonneoplastic lesions, while benign neoplasia was more common than malignant neoplasia. In contrast to the western reports, the commonest malignant neoplasm was sebaceous carcinoma.

Malignant eyelid tumors: epidemiology and clinical observation of patients in Moscow

Purpose: to assess the prevalence of primary malignant eyelid tumors and their prognostic features based on the materials of the ocular oncology department, Moscow Ophthalmological Center. Materials and methods. We performed a retrospective analysis of 10-year array (2010–2019) of documents of the Moscow Cancer Register, reports of the ocular oncology department of the Moscow ophthalmological center, S.P. Botkin State Clinical Hospital, and case histories of outpatients with malignant eyelid tumors, residing in Moscow. Results. Malignant ocular tumors were diagnosed in 3650 people. Of these, 75.29 % were eyelid tumors (2748 people). The most common malignant tumor was basal cell carcinoma (89.19 %), which was morphologically diagnosed and over the ten years showed an incidence increase of almost a third. The occurrence rate grows with age, with the peak observed between 70 and 79 years of life. Most often, the lower eyelid (64%) and the inner corner (22.14 %) are affected. Less common are tumors located in the upper eyelid (12.21 %) and at the lateral canthus — 2.3 %. Over 80 % of the relapses occurred at the T2–T3 stages, while only 18.2 % were eyelid skin cancers treated at the T1 stage. Tumors located in the inner corner of the palpebral fissure recurred up to 3 times more often than differently localized eyelid tumors. Conclusion. Malignant eyelid tumors are the most common of malignant ocular neoplasms, claiming ¾ of them. Basal cell carcinoma is the most common type. The peak incidence falls upon the 7th and the 8th decades of life. An increase in the incidence of malignant tumors of the eyelids is observed. The special ophthalmic-oncological service facilitates the diagnostics, treatment and dispensary observation of patients after treatment, which contributes to the early detection of relapses.

Potential Delay of Diagnosing Infraorbital Skin Tumors Due to Coverage by Face Masks During the COVID-19 Pandemic: An Observational Study

Aim

To assess the potential danger of belated diagnosis or underdiagnosis of cutaneous infraorbital pathologies that are partially or fully covered by face masks worn due to the COVID-19 pandemic.

Methods

We evaluated data of 257 patients with infraorbital pathologies presenting at a large tertiary German university center between 04/2020 and 06/2021. This mono-centric, retrospective analysis included descriptive statistics and non-parametric tests.

Results

Out of 257 cutaneous infraorbital pathologies, 32 (12.5%) were partially and 20 (7.8%) fully covered by the required face mask. Significantly more patients with lesions that were partially or fully covered came from a single household (p=0.003, Fisher's exact test) with 125 (48.6%) patients reportedly living alone. In patients with multiple periocular pathologies (n = 51, 19.8%), the risk of at least one periocular lesion being covered by the face mask was significantly elevated (p=0.009, Fisher's exact test). As expected, malignant tumors were significantly larger than benign pathologies (largest diameter, malignant median 9.0mm, range 1.3-34.0mm, mean 10.5mm, and benign median 3.0mm, range 1.0-7.0mm, mean 4.3mm, respectively; p<0.001, Mann-Whitney-U test) and patients presenting with malignant lesions were significantly older (median age 78.4, range 33-93, mean 73.7 years versus median age 57.9, range 18-90, mean 59.8 years, respectively; p<0.001, Mann-Whitney-U test). Additionally, in subgroup analysis, patients with malignant lesions coming from single households were significantly older (p=0.041, Mann-Whitney-U test).

Conclusion

For adequate and timely treatment of infraorbital lesions, patients should be examined without their face mask. This is of utmost importance for the elderly (being at greater risk for malignant pathologies) and patients coming from single households. The presence of multiple pathologies must always be excluded.

Trial Registration Number

Not applicable.

Deep learning-based fully automated differential diagnosis of eyelid basal cell and sebaceous carcinoma using whole slide images

Background

The differential diagnosis of eyelid basal cell carcinoma (BCC) and sebaceous carcinoma (SC) is highly dependent on pathologist’s experience. Herein, we proposed a fully automated differential diagnostic method, which used deep learning (DL) to accurately classify eyelid BCC and SC based on whole slide images (WSIs).

Methods

We used 116 haematoxylin and eosin (H&E)-stained sections from 116 eyelid BCC patients and 180 H&E-stained sections from 129 eyelid SC patients treated at the Shanghai Ninth People’s Hospital from 2017 to 2019. The method comprises two stages: patch prediction by the DenseNet-161 architecture-based DL model and WSI differentiation by an average-probability strategy-based integration module, and its differential performance was assessed by the carcinoma differentiation accuracy and F1 score. We compared the classification performance of the method with that of three pathologists, two junior and one senior. To validate the auxiliary value of the method, we compared the pathologists’ BCC and SC classification with and without the assistance of our proposed method.

Results

Our proposed method achieved an accuracy of 0.983, significantly higher than that of the three pathologists (0.644 and 0.729 for the two junior pathologists and 0.831 for the senior pathologist). With the method’s assistance, the pathologists’ accuracy increased significantly (P<0.05), by 28.8% and 15.2%, respectively, for the two junior pathologists and by 11.8% for the senior pathologist.

Conclusions

Our proposed method accurately classifies eyelid BCC and SC and effectively improves the diagnostic accuracy of pathologists. It may therefore facilitate the development of appropriate and timely therapeutic plans.

Dermoscopic features of eyelid margin tumors: A single-center retrospective study

Despite rapid growth in the significance of dermoscopy in dermatological oncology, relatively little is yet known about the dermoscopic patterns of eyelid margin tumors. The aim of the study was to analyze the dermoscopic features of eyelid margin tumors. This was a retrospective, single-center, consecutive study which included clinical and dermoscopic analysis of eyelid margin tumors diagnosed at the Department of Dermatology, Venereology and Allergology at the Medical University of Gdańsk from 1 June 2016 to 31 December 2020. Dermoscopic features significantly more prevalent in malignant non-melanocytic lesions compared to benign ones were alteration in eyelash growth, structureless pink areas, starry milia-like cysts, and perpendicular vessels. In contrast, there were no dermoscopic features that occurred significantly more frequently in malignant melanocytic lesions when compared to benign ones. Basal cell carcinoma, in comparison to hidrocystoma, more commonly presented with ulceration and structureless pink areas. The main features differentiating basal cell carcinoma from dermal nevus were the presence of ulceration, alteration in eyelash growth, structureless pink and structureless white areas, and perpendicular vessels within the tumor with each of these features observed more commonly in basal cell carcinoma. Blue nevus, hemangioma, or pigmented hidrocystoma presenting exclusively with blue structureless areas may be difficult to differentiate based on dermoscopy. The study offers additional dermoscopic clues in the assessment of eyelid margin tumors. Some observations reported previously to be typical of basal cell carcinoma (e.g., linear vessels arranged perpendicularly to the eyelid margin) were documented also within the normal eyelid margin accompanying other cases, and according to our study, cannot be useful as a pathognomonic feature. In contrast, it seems that yellow structures (half-moon sign, starry milia-like cysts) may be important dermoscopic features, though further studies are needed to confirm our observations.

Artificial intelligence to detect malignant eyelid tumors from photographic images

Malignant eyelid tumors can invade adjacent structures and pose a threat to vision and even life. Early identification of malignant eyelid tumors is crucial to avoiding substantial morbidity and mortality. However, differentiating malignant eyelid tumors from benign ones can be challenging for primary care physicians and even some ophthalmologists. Here, based on 1,417 photographic images from 851 patients across three hospitals, we developed an artificial intelligence system using a faster region-based convolutional neural network and deep learning classification networks to automatically locate eyelid tumors and then distinguish between malignant and benign eyelid tumors. The system performed well in both internal and external test sets (AUCs ranged from 0.899 to 0.955). The performance of the system is comparable to that of a senior ophthalmologist, indicating that this system has the potential to be used at the screening stage for promoting the early detection and treatment of malignant eyelid tumors.

Clinicopathological Analysis and Surgical Outcome of Eyelid Malignancies: A Study of 332 Cases

Background

Eyelid tumours are common in our ophthalmic practice. Malignancy cases account only for one-fourth of all eyelid tumours. The most aggressive eyelid malignancy is sebaceous gland carcinoma, but its occurrences are rare in western countries. We found sebaceous gland carcinoma is as common as basal cell carcinoma in our clinical practices. Hence, it is essential to build awareness about the more aggressive eyelid malignancies to reduce morbidity and mortality.

Aim

To assess the relative frequency of eyelid malignancies in the Bangladesh population, state their clinical features and outcome of management strategies and build awareness about the more aggressive eyelid malignancies to reduce morbidity and mortality.

Methods

This was a retrospective case series study of 332 patients in Bangladesh. This study analyzed all the recorded data of the histologically proven primary eyelid malignancies and followed them up for at least six months from 2014 to 2019 (6 years). All patients were managed by surgical excision with tumor-free margins verified on histopathology, either the frozen section or excision biopsy with 2–3 mm microscopic view of normal tissue followed by eyelid reconstruction. Computer-based statistical software SPSS was used for the analysis, and an appropriate test of significance (chi-square) was used for the statistical analysis.

Results

Sebaceous gland carcinoma (SGC) was the highest in occurrence, at 42%, followed by 38% basal cell carcinoma (BCC), 18% squamous cell carcinoma (SqCC), and 02% malignant melanoma (MM). The mean age at presentation of SGC, BCC, SqCC, and MM were 57.41 years, 62.56 years, 64.73 years, and 59.28 years, respectively. Female (59%) was slightly more preponderance over the male (41%) for SGC than other malignancies. Pigmentation was associated with malignant melanoma (100%) and BCC (81%). Statistically, a significant difference was found between eyelid malignancies, including location, size, pigmentation, recurrence, and invasiveness. The recurrence rate was low lower in the patients who underwent frozen section biopsy (3%) for margin clearance than those who underwent excision biopsy (21.5%) in the follow-up time. Conjunctival map biopsy (8%) was performed as an essential tool for excluding the pagetoid spread of SGC. A new reconstruction method named triangular-shaped musculocutaneous tail flap was performed in 33 (11%) patients to reconstruct the moderate eyelid defect following local resection.

Conclusion

Sebaceous gland carcinoma (SGC) was the highest occurrence found to be the highest occurrence among all eyelid malignancies in Bangladesh. SGC is more aggressive and the recurrence rate was higher than BCC and SqCC.

Outcomes of lacrimal punctal tumors treated with a superpulse CO2 laser

Literature on lacrimal punctal tumors is limited due to their rarity. Our aim in this study was to evaluate the clinicopathological characteristics of these tumors and assess functional and aesthetic outcomes after CO₂ laser ablation with silicone stent intubation. A retrospective consecutive study was conducted from December 2013 to November 2020. All patients who received CO₂ laser ablation with silicone intubation for their punctal tumors at National Cheng Kung University Hospital, a tertiary hospital in Taiwan, were included in this study. Demographic and clinical information was gathered during preoperative and follow-up visits. Thirty-three Han Chinese patients with a solitary punctal tumor were included in this study. Demographically, we found a female predominance (75.8%), and most tumors were located at the lower punctum (69.7%). The incidence of melanocytic nevus was higher in punctal tumors (78.8%) than in benign eyelid tumors (22.3%). Irrigation tests were performed in the 33 patients during follow-up visits, all of whom exhibited patency of the lacrimal system. No patient complained of epiphora after surgery. Thirty-two patients (97%) were satisfied with the aesthetic outcome after surgery. Superpulse CO₂ laser ablation followed by silicone stent intubation is a safe and effective treatment for benign punctal tumors. In addition, compared to those of eyelid tumors, the clinicopathological characteristics of lacrimal punctal tumors are different, and melanocytic nevus was the main cause of these tumors.

Eyelid Tumours in Northern Malaysia: A Five-Year Review

Background The majority of eyelid tumours are benign in nature and constitute 82%-98% of all eyelid tumours. This study aimed to explore the prevalence and frequency of histopathological diagnoses of eyelid tumours encountered in Hospital Sultanah Bahiyah (HSB), Malaysia, from 2016 to 2020. Method This study is a case series of 136 patients with eyelid tumours who underwent eyelid biopsy. Result Twenty-three (17%) patients were below 18 years old, 64 (47%) patients were between 19 and 64 years old and 49 (36%) patients were more than 65 years old. The mean age in this study was 47.9 ± 25.4 years. The most common benign eyelid tumours were dermoid cyst (31, 22.8%), melanocytic nevus (19, 14%), granuloma (17, 12.5%), squamous cell papilloma (13, 9.6%) and epidermal cyst (12, 8.8%). Most of the benign eyelid tumours occurred at the upper lids (79.8%), and most of the malignant eyelid tumours occurred at the lower lids (81.8%). The most common malignant eyelid tumours were basal cell carcinoma (BCC) (6, 14.3%), followed by malignant lymphoma (3, 6.1%) and sebaceous gland carcinoma (2, 4.1%). Eight out of nine cases of BCC were located at the lower lids. All malignant lymphomas were primary lymphoma. Five were extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT), and one was follicular lymphoma. All cases with benign and malignant tumours required only a single surgery for excision, and none of the cases had a recurrence. Conclusion There were limited references to the epidemiology of histopathological diagnoses of eyelid tumours in Malaysia. Although benign lesions comprise the majority of eyelid tumours, it is essential to delineate between benign and malignant eyelid tumours.

The prevalence of various eyelid skin lesions in a single-centre observation study

Introduction

The role of the eyelids is to protect and moisturise the eye. Despite its small relative surface area, 5–10% of skin cancers originate in the eyelids.

Aim

To assess the prevalence of different types of skin lesions in the area of eyelids based on retrospective histopathology data from a tertiary centre.

Material and methods

Among 544 included eyelid lesions, 429 (79%) were benign and 115 (21%) were malignant. In the benign group, the most common finding was a chalazion (49.2%) followed by squamous papilloma (22.8%), seborrheic keratitis (10%), epidermal cyst (8.2%), and intradermal nevus (5.1%). Out of all malignant lesions, the most common diagnosis was basal cell carcinoma (BCC) in 110 (95.7%) patients.

Results

Squamous cell carcinoma (SCC) was diagnosed in 3 (2.6%) patients and sebaceous gland carcinoma (SGC) in 2 (1.7%). No malignant melanoma was identified in the studied group.

Conclusions

Although benign lesions are the most common eyelid tumours, it is essential to differentiate between benign and malignant eyelid tumours because early detection and appropriate treatment may improve the cosmetic effect and reduce recurrences.

Case Series of Laser Therapy of Eyelid Peripunctal Benign Tumor

Objective: This study is the first time to explore the feasibility of CO₂ laser treating some eyelid lacrimal puncta benign tumor. Background: Eyelid lacrimal papillae is special anatomy region. Treatment of eyelid peripunctal tumor is relatively intractable and needs reconstruction of the lacrimal passage in most of the time. We use super pulse CO₂ laser to treat peripunctal benign tumor and appears to be effective. Materials and methods: It contained 12 participants treated with super pulse CO₂ laser photocoagulation without lacrimal duct silicone tube placement. The areas of lesions were as follows: eight cases were located in the upper eyelid lacrimal puncta, four cases in the lower lacrimal puncta. Super pulse CO₂ laser was used to treat it. The follow-up period was 4 weeks, 24 weeks, and 3 years after treatment. Histological diagnoses were obtained in all patients. Results: All patients were satisfactory after treatment with their cosmetic outcomes, and the wounds are dry, with no infections. No patient has functional damage, secondary epiphora, and lacrimal drainage system obstruction. Complete epithelialization occurs 2-4 weeks after treatment and forms normal epithelium. It showed no obvious scars or notches after treatment, and only temporarily less hyperpigmentation is in the treated area than the circumambient normal skin. During the follow-up period, there were no complications and no relapses were observed. Conclusions: Super pulse CO₂ laser therapy for eyelid peripunctal benign tumors without lacrimal duct silicone tube placement sometime appears to be available, effective, and well-tolerated alternative to traditional surgery in the clinic, especially for selected disease. The IRB proved number is 2016034.

Ten-year epidemiological study of ocular and orbital tumors in Chiba University Hospital

Background

The purpose of this study is to determine the epidemiology of tumors of the ocular adnexa and orbit in Japan.

Methods

We conducted a retrospective study on the histopathological reports in the medical records of the Chiba University Hospital from April 2009 to March 2019. Three hundred and seventy two records were examined. In addition, we examined the annual changes in the major types of tumors including malignant lymphomas and IgG4-related diseases (IgG4-RDs).

Results

There were 270 conjunctival or eyelid tumors with 166 benign and 104 malignant. There were 102 orbital tumors with 55 benign, 47 malignant tumors, and 21 cases of IgG4-RDs. Ten cases of adenoma (2.7%), another benign tumor, was also diagnosed. The major malignant tumors were malignant lymphoma in 74 cases, sebaceous gland carcinoma (SGC) in 28 cases, basal cell carcinoma in 15 cases, and squamous cell carcinoma in 8 cases. The SGCs were the most common malignant eyelid tumor at 54%. Among the malignant lymphomas, extranodal marginal zone lymphomas of the mucosa-associated lymphoid tissue type, MALT lymphomas, was the most common at 51 cases and the second most common was the diffuse large B-cell lymphoma at 11 cases. The ratio of MALT lymphomas to that of all malignant lymphomas increased significantly with years. The serum IgG4 values were measured more often in the last 5 years (70%) than in the former 5 years (33%).

Conclusions

We conclude that malignant lymphoma is a major malignant tumor in Japan and pathological biopsies should be done proactively to prevent missing IgG4-positive MALT lymphomas.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12886-021-02108-w.

Clinical and pathological diagnosis and comparison of benign and malignant eyelid tumors

PURPOSE

To assess and compare demographic and clinical features of benign and malignant eyelid tumors from 2011 to 2018 in a tertiary medical center.

MATERIALS AND METHODS

The study was conducted retrospectively from medical records to compare demographic and clinical characteristics and recurrence of benign and malignant eyelid tumors after obtaining institutional review board approval. A total of 428 eyelid tumors with histopathologic diagnoses were studied. Premalignant lesions were not included. The lesions were classified into two groups according to malignancy: benign and malignant eyelid lesions.

RESULTS

Among the 428 histopathologically confirmed eyelid lesions, 373 (87.1%) were benign and 55 (12.9%) were malignant. The patients with malignant eyelid tumors had a higher mean age at diagnosis than patients with benign eyelid tumors (P=0.012). The most common benign eyelid tumors were squamous papilloma (17.7%), xanthelasma (11.5%), and epidermal cysts (11.3%). The most common malignant eyelid tumors were basal cell carcinomas (65.5%), squamous cell carcinomas (14.5%), and sebaceous gland carcinomas (7.3%). There was no relative gender predominance between patients with benign and malignant eyelid tumors (P=0.287). Benign eyelid tumors were most commonly located on the right side and upper eyelid (P=0.027 and 0.036, respectively). Malignant tumors had a higher rate of recurrence (P=0.002).

CONCLUSION

Differentiation between benign and malignant eyelid lesions is important, since it may lead to cosmetic complications and serious morbidity, particularly in patients with malignant eyelid tumors.

Clinicopathological analysis of 5146 eyelid tumours and tumour-like lesions in an eye centre in South China, 2000-2018: a retrospective cohort study

OBJECTIVES

To describe the clinicopathological characteristics of patients with eyelid tumours and tumour-like lesions in South China, investigate possible factors affecting tumour constitution.

DESIGN

Retrospective cohort study.

SETTING

All patients diagnosed with eyelid tumours were included from a high-volume tertiary eye care centre from South China which caring for over 2000 patients per day. All biopsied specimens were reviewed by two senior pathologists and were classified according to the fourth edition of the WHO Classification of Skin Tumours.

PARTICIPANT

A total of 5146 cases of eyelid lesions were reviewed from 2000 to 2018, being classified by histogenesis and pathologic diagnosis, being compared with data from previous literature containing different races.

MAIN OUTCOME MEASURES

Age-specific and gender-specific incidence constitutions, time trends, tumour location, distribution in different age groups and relationship with Sociodmographic Index (SDI) were calculated.

RESULTS

Benign tumours accounted for 85.08% (4378) of all cases, among which, nevus was most common (33.07%). Eight of top 10 benign lesions had higher occurrence in upper eyelids. The R² value of linear regression in patient annual number of benign lesions were 0.946 (p<0.01) for male and 0.914 (p<0.01) for female. More than 33.60% (1471/4378) were made up by patients younger than 40 years. The number of patients undergoing removal of benign lesions decreased with age. Among the malignant lesions, basal cell carcinoma (BCC) was most prevalent (48.70%), followed by sebaceous gland carcinoma (34.24%) and majority (81.8%) occurred in patients above 60 years.

CONCLUSIONS

Over the past 19 years, most eyelid tumours occurred at our centre were benign lesions. The number of patients presenting with benign lesions increased in both genders, especially among young females who were more likely to request surgeries. Among malignant lesions, BCC remains the most common type, appears a higher incidence in countries with higher SDI.

Demographic features and histopathological diagnosis in primary eyelid tumors: results over 19 years from a tertiary center in Ankara, Turkey

AIM

To evaluate the demographic features, location, and histopathologic results in primary eyelid tumors.

METHODS

We retrospectively reviewed the records of patients with primary eyelid tumor diagnosed and treated between November 1997 and June 2016 on our service.

RESULTS

Nine hundred and eleven lesions from 874 patients were included in this study. Four hundred and forty-six (51.0%) of the patients were females and 428 (49.0%) were males. The mean age was 51.0y (range: 3mo-94y). The lesions were located in the upper eyelid (418 cases, 45.9%), lower eyelid (378 cases, 41.5%), medial canthus (89 cases, 9.8%), and lateral canthus (26 cases, 2.8%). Four hundred and seventy (51.6%) lesions were located on the right side and 441 (48.4%) on the left. Of the eyelid lesions, 666 (73.1%) were benign, 230 (25.2%) malignant, and 15 (1.6%) premalignant. When the eyelid tumors were classified according to their tissue or cell of origin, 527 (57.8%) of the lesions were found to be epidermal, 171 (18.8%) adnexal, 131 (14.4%) inflammatory and infectious, and 65 (7.1%) stromal. The most common benign lesions were squamous cell papilloma (139 lesions, 15.2%), intradermal nevus (97 lesions, 10.6%), epidermoid inclusion cysts (78 lesions, 8.6%), seborrheic keratosis (60 lesions, 6.6%), and inflammatory masses (59 lesions, 6.5%). Basal cell carcinoma was the most common malignant tumor (191 lesions, 21.0%) followed by squamous cell carcinoma (16 lesions, 1.8%), sebaceous carcinoma (14 lesions, 1.5%), and malignant melanoma (5 lesions, 0.5%).

CONCLUSION

In this study, 73.1% of eyelid lesions are benign and the remaining 26.9% are premalignant and malignant. Basal cell carcinoma is the most common tumor among all histopathological diagnosis followed by squamous papilloma.

Evaluation of Demographic Features of Eyelid Lesions

OBJECTIVES

This study was an evaluation of demographic and histopathologic features of eyelid lesions.

METHODS

The medical records of 261 patients (296 eyelid lesions) who attended a single clinic between 1997 and 2011 were examined retrospectively. The incidence of benign and malignant lesions, the pathological classification, and age and sex data were investigated.

RESULTS

A total of 204 benign lesions (68.9%) and 92 malignant neoplasms (31.1%) were found. Among these, the most frequently seen types of benign neoplasms were xanthelasma (28.4%), papilloma (14.7%), chalazion (8.8%), nevus (6.4%), moll cyst (5.9%), and capillary hemangioma (4.9%). The most frequently seen malignant neoplasms were basal cell carcinoma (72.8%), squamous cell carcinoma (13%), and sebaceous gland carcinoma (5.4%). The study group was made up of 149 (57%) female patients and 112 (43%) male patients. The majority of benign lesions were seen in women, whereas malignant neoplasms were observed more often in male patients. The mean age of patients with benign lesions and malignant neoplasms was 38.1±21.7 and 62.7±15.3 years, respectively. Benign lesions involved the upper eyelid more frequently than the lower, while malignant lesions were seen more frequently in the lower eyelid, with the exception of sebaceous gland carcinoma.

CONCLUSION

The majority of eyelid lesions were benign and malignant neoplasms were seen more frequently in the older population. Basal cell carcinoma was the most common malignant eyelid tumor. The most common site of malignant tumor origin was the lower eyelid, with the exception of sebaceous gland carcinoma.

Clinical Characteristics and Outcome of Malignant Eyelid Tumors: A Five-Year Retrospective Study

Introduction

To the best of our knowledge, this is the first study about malignant eyelid tumors in the region of Tuzla, Bosnia and Herzegovina, and it shows similar results comparing with other countries (the annual incidence of eyelid tumors in Tuzla region is about 3.73/100 000 population). Malignant eyelid tumors are relatively uncommon, but potentially fatal disease. However, if detected early and treated adequately, the prognosis is generally excellent.

Aim

The aim of this study was the clinical and microscopical analysis of malignant eyelid tumors in treated patients, the presentation of surgical treatment and reconstructive methods of eyelid tumors.

Methods

This retrospective study included 60 patients surgically treated at the University Clinical Center Tuzla from January 2012 to December 2016, who were initially diagnosed with malignant eyelid tumors in accordance to the final results obtained by histological examination of excised lesions.

Results

In the group of malignant tumors, the most common tumors were BCC (85%), which were predominantly found on the lower eyelids (92.16%) and showed female predominance (51.06%). SCC was the second most common eyelid malignancy (15%) and showed a predilection for the lower eyelid involvement and male predominance (55.56%). Tumors up to 2 cm in diameter (clinical stage T1) were found in 78.33% of cases, 95.74% of which with radical excision, while 4.26% with non-radical excision.

Conclusion

Treatment by complete excision with histological confirmation of tumor clearance is recommended. Perineural spread is an adverse prognostic sign, which may require postoperative radiotherapy. Orbital invasion is a rare complication but, if recognized early, it can be treated effectively with exenteration. Because presentation varies and histological examination is required for accurate diagnosis, any suspicious lesion occurring on the eyelids should be excised or biopsied. All patients with malignant tumors should be advised of the risk of recurrent or new tumors and encouraged to attend lifelong follow up.

Palpebral cutaneous melanomas: a review of 17 cases from a tertiary center

BACKGROUND

Melanomas arising from eyelid skin are exceptionally rare, accounting for <1% of eyelid malignancies and all cutaneous melanomas. The aim of this study was to identify the histopathological features and clinical behaviors of the palpebral skin melanoma patients from a single tertiary institution.

PATIENTS AND METHODS

Seventeen Caucasian patients diagnosed with eyelid cutaneous melanoma were analyzed retrospectively.

RESULTS

The median age of patients was 59 years, and females were predominant (n = 11). The most frequent localization of the lesions was the lower eyelid (n = 8). Nodular (n = 4), lentigo maligna (n = 3), and the superficial spreading melanoma (n = 3) were the most common histopathological subtypes. Only three patients had in situ melanomas. Tumor infiltrating lymphocytes were present in most of the patients; however, only a few cases had lymphovascular invasion. Regional lymph node involvement was present in two patients, and distant metastasis was found in only one patient. Four patients (24%) had disease relapses during follow-up, all of which were locoregional. The median relapse-free survival (RFS) time and 5-year RFS rate were 26.3 months and 60.4%, respectively. Two patients (12%) died. Median OS time was 32.1 months, and 5-year OS rate was 84%. Being elderly (older than 60 years of age) (P = 0.05), lesion originating from canthus compared to eyelid (P = 0.03) and presence of recurrence in follow-up (P = 0.04) have been found as poor prognostic indicators for OS.

CONCLUSION

Palpebral skin melanoma is associated with favorable clinical features, and it is correlated with better survival rates.

A retrospective study of 2228 cases with eyelid tumors

AIM

To describe the histopathologic and clinical features of eyelid tumor cases from Tianjin Eye Hospital during 2002 to 2015.

METHODS

In this retrospective study, a total of 2228 cases of eyelid tumors with pathologic diagnoses were enrolled. The eyelid tumors were classified into three groups according to tumor origin: epidermal, adnexal and miscellaneous, including melanocytic, neural and vascular lesions. Inflammatory tumor-like lesions were excluded. The clinical characteristics of the eyelid tumors were analyzed, including age, gender and lesion location.

RESULTS

Most eyelid tumors were epidermal in origin (1080, 48.5%), followed by miscellaneous (885, 39.7%) and adnexal tumors (263, 11.8%). Among all the tumors, 292 (13.1%) were malignant lesions, 1910 (85.7%) benign and 26 (1.1%) premalignant lesions. Most malignant tumors originated from epidermal cells (60.0%), followed by adnexal cells (34.6%). The most common malignant tumors were basal cell carcinomas (56.5%) followed by sebaceous carcinoma (34.6%), squamous cell carcinomas (3.8%) and lymphoma/plasmocytoma (1.7%). The benign and premalignant eyelid lesions mostly originated from epidermal cells (46.4%) followed by miscellaneous cell sources (45.2%), including melanocytic nevus (33.8%), seborrheic keratosis (13.7%), squamous cell papilloma (13.0%) and epidermal cysts (11.5%).

CONCLUSION

Eyelid tumors are mostly epithelial in origin. Benign tumors are significantly more common than malignant tumors with an obvious female predominance, and the most frequent malignant tumor are basal cell carcinoma, sebaceous carcinoma and squamous cell carcinomas. The tumor clinical features varied among the different subtypes.

Malignant Eyelid Tumors in India: A Study of 536 Asian Indian Patients

Purpose

To study the proportion of eyelid malignant tumors in an Asian Indian population and to review their clinical features and outcomes.

Methods

This is a retrospective study of 536 patients.

Results

The mean age at presentation with eyelid malignancy was 58 years. Histopathology-proven diagnoses of these patients included sebaceous gland carcinoma (SGC) (n = 285, 53%), basal cell carcinoma (BCC) (n = 128, 24%), squamous cell carcinoma (SCC) (n = 99, 18%), and miscellaneous tumors (n = 24, 4%). The statistically significant differences between eyelid malignant tumors included age at presentation, tumor location, and tumor extent. The clinicopathological correlation of SGC, BCC, SCC, and miscellaneous tumors was 91, 86, 46, and 38% (p = 0.001), respectively. Comparing SGC with BCC, SCC, and miscellaneous tumors, SGC was more commonly associated with tumor recurrence (21 vs. 3, 8, and 13%; p = 0.001), systemic metastasis (13 vs. 0, 4, and 13%; p = 0.001), and death (9 vs. 0, 4, and 0%; p = 0.004). Compared to SGC, BCC, and SCC, locoregional lymph node metastasis was more common with miscellaneous tumors (26 vs. 16, < 1, and 8%; p = 0.001) over a mean follow-up period of 19 months.

Conclusion

In Asian Indians, SGC is twice as common as BCC and 3 times more common than SCC. SGC is associated with poorer prognosis compared to other eyelid malignant tumors.

Isolated neurofibroma of the eyelid mimicking recurrent chalazion

Neurofibroma is a peripheral nerve sheath tumor which is seen in neurofibromatosis type 1 and is characterized by various ophthalmic manifestations. Solitary neurofibroma of the eyelid is rare. We report a case of a 53-year-old female patient who presented with a painless swelling in the left upper lid of 4 years’ duration. She had undergone surgery for the same lesion twice. The lesion was excised and histopathological examination revealed a solitary neurofibroma. She did not have any other features of generalized neurofibromatosis.

Solitary neurofibroma of eyelid masquerading as chalazion

Neurofibroma, a benign peripheral nerve sheath tumor, usually appears together with café-au-lait spots, iris nodules, and other tumors within the scope of neurofibromatosis von Recklinghausen type 1 tumors. A solitary neurofibroma of the eyelid is relatively rare. In this case report, we present a 39-year-old woman who had a lesion on the eyelid crease, previously treated as a chalazion. Due to persistent wound crusting, the lesion was excised above the tarsus. Pathological examination revealed a solitary neurofibroma. The patient did not have other clinical symptoms of neurofibromatosis, and there was no recurrence of the nodule during the 1-year follow-up.