Mohs Micrographic Excision of Sebaceous Carcinoma of the Eyelids

BACKGROUND: Sebaceous carcinoma of the eyelid is a difficult tumor to manage because of diagnostic difficulties and pagetoid-type spread in the conjunctivae. OBJECTIVE: We report our experience with eight patients using the Mohs technique of excision with reconstruction. METHODS: Six cases were managed with paraffin-embedded hematoxylin and eosin sections. One case was managed by frozen histologic sections and one was managed with frozen section processing followed by paraffin-embedded section review. RESULTS: The correct pathologic diagnosis was made initially in only 50% of the cases. Eighty-eight percent of the cases revealed intraepithelial neoplasm. There has been one recurrence with metastatic disease. The average follow-up period has been 56.8 months. CONCLUSIONS: We advocate early recognition and excision with the Mohs technique with paraffin-embedded sections followed by reconstruction. The use of paraffin-embedded histologic sections helps with interpretation of intraepithelial and pagetoid tumor spread.