Treatment options and future prospects for the management of eyelid malignancies: an evidence-based update.

PURPOSE: To provide evidence-based clinical recommendations for treatment options and future prospects for the management of common malignant eyelid tumors, including global ratings for the strength of published evidence supporting them.

CLINICAL RELEVANCE: Approximately 5% to 10% of all skin cancers occur in the eyelid. Incidence studies indicate that basal cell carcinoma is the most frequent malignant eyelid tumor, followed by squamous cell carcinoma, sebaceous 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-text references retrieved regarding treatment of malignant eyelid tumors. These sources then were used to prepare recommendations for patient care. Each recommendation was rated according to: (1) its importance in the care process and (2) the strength of evidence supporting the given recommendation.

RESULTS: All recommendations were rated as level A (very important to patient-care outcome). For basal cell carcinoma, squamous cell carcinoma, and sebaceous gland carcinoma, the published evidence supporting two recommendations (Mohs' micrographic surgery or excision with frozen-section control) were graded as I (providing strong evidence in support of a recommendation). For sebaceous gland carcinoma, the recommendations also included conjunctival map biopsies. The published evidence supporting all other recommendations for these three eyelid tumors were graded II (substantial evidence in support of a recommendation), primarily because of the small numbers of patients 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 III, 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-free margins of excision.