Eyelid Malignancies in Bangladesh:

A Clinico-pathologic study

Authors:

Dr Syeed Mehbub Ul Kadir

Dr Golam Haider

Dr Murtuza Nuruddin

Dr Mukti Rani Mitra

BOSS Annual Conference” 2014

Disclosure of the Conflict of interest

Dr Syeed Mehbub Ul KadirConsultant, Dept of Orbit & Oculoplasty Services

National Institute of Ophthalmology & Hospital

Dhaka, Bangladesh

In relation to this presentation, I declare that there are no conflicts of interest.

Introduction

Eyelid malignancies are common disorder

Basal cell Ca. (BCC), Sebaceous gland Ca (SGC) &

Squamous cell Ca are common lid cancer

It is curable if detected earlier

Management depends on size, position, type &

invasiveness of the lesion

Countries BCC SGC SqCC

Western countries 90-95% 01% 5-10%

India 44.5% 27% 14.8%

Korea 36.8% 42% 10.5%

Jeong S et al. Extensive destruction of eyeball by invasion of basal cell

carcinoma of the eyelid. Jpn J Ophthalmol. 1998; 43: 300-302

Jahagirdar SS et al. A clinicopathological study of eyelid malignancies from

central India. 2007; 55: 109-113.

Purpose

The characterize the nature, rate, associated

risk factors and management strategies of

different types of eyelid malignancies in Bangladesh

Methods

Multicentre observational case series study

2008 to 2013 (6 yrs study)

Clinically evaluated eyelid malignancies

We excluded lymphoma, conjunctival & orbital

malignancies involving the eyelid.

Methods

Excision biopsy / frozen section biopsy

Histopathology confirmed the diagnosis

Apropriate Reconstruction

Data collection : Predesigned data- sheet

with Pre & post operative photgraph

ResultsType No of Cases Percentage

Basal Cell Carcinoma 65 39.6

Sebaceous Gland Carcinoma 67 40.8

Squamous Cell Carcinoma 29 17.6

Malignant Melonoma 02 1.2

Apocrine Adonocarcinoma 01 0.6

Total 164 100

Age distribution

Types ≤ 45 yrs 46-70 yrs ≥ 71 yrs χ² value, dfP Value

BCC 12% 54% 34% 19.01

SGC 24% 66% 10%

SqCC 07% 52% 41% 08

MM 50% 50% 00

AA 00 100% 00 < 0.05

Mean age

Eyelid Malignancies Mean age (yrs)

SGC 56.3 yrs

BCC 60.7 yrs

SqCC 64.1 yrs

MM 52.5 yrs

Gender Distribution

Associated risk factors

53 %

37 %

23 %

(Prolong sun exposure 30 hrs/wk)

Location

Eyelid BCC SGC SqCCP value

Upper 21% 81% 48%

<0.001Lower 79% 19% 52%

Orbit : 3.6%

Lymph node: 7.3%

Metastatsis: 1.2%

Procedure of Surgery

Excision ē 4 mm normal tissue 86 cases (52.4%)

Frozen section biopsy 72 cases (44%)

Exenteration 6 cases (3.6%)

Reconstruction No %Direct Closure 52 31

Semicircular Flap 30 19

Triangular flap 17 10

Cutler beard procedure 18 11

Hughes procedure 23 14

Mastard cheek rotational flap 05 03

Z-Plasty 03 02

Skin graft 16 10

BeforeSurgery

After

Clinical vs Confirmatory diagnosis

Clinical Dx

BCC SGC SqCC χ²P value

BCC 63 (94%) 2 239.25

SGC 1 64 (97%) 1 < 0.001***

SqCC 1 1 26 (93%)

Recurance rate

1 case after 3 yrs of frozen section biopsy, 1.4%

5 cases ē in 2 yr of excisional biopsy, 6%

Discussion

A report from USA: BCC-90%, SqCC-

5% & SGC-4% (Holds et al．２００

８）

Our study: SGC- 40.8%, BCC- 39.6%

& Sｑ CC-17.6%.

Age: 34 -100 yrs, > 45 yrs: 85%

Discussion

Betel leaf & nut is common risk factor

Lower Lid: 79% in BCC

Upper lid: 81% in SGC

Metastasis found in SGC

Frozen section biopsy is better option

Take home message

Sebaceous gland Ca. is highest in occurrence in BD

Frozen Section is preferred method

Early Dx & Mx may reduce the ocular morbidity

Thank you all

Beautiful Bangladesh