Intraepidermal carcinoma of the eyelid

To examine the clinical and pathological features and treatment outcomes of cutaneous squamous intraepidermal carcinoma of the eyelid in order to determine its behaviour, its relationship to squamous cell carcinoma and appropriate management.

All patients from the practice of one of the authors with a histological diagnosis of squamous intraepidermal carcinoma were included. Retrospective chart review was performed, and pathology re-examined. All patients were recalled for examination. Histological diagnosis of periocular intraepidermal carcinoma, lesion characteristics, outcome of surgical excision, local recurrence, and occurrence of metastasis were assessed as main outcome measures.

Thirty-one white, usually fair-haired patients had a total of 37 lesions. Most had a history of occupational or recreational sun exposure. Other predisposing factors included exposure to arsenic, petroleum by-products and epidermodysplasia verruciformis. All except one had other solar keratoses and non-melanoma skin cancers. All had surgical excision. Six cases (16%) had evidence of progression to squamous cell carcinoma. Seven cases (18%) had local recurrence successfully treated by further local excision. No patient had perineural spread or distant metastasis.

This lesion, which serves as a marker for severe actinic damage, may masquerade as chronic blepharitis. Early diagnosis prior to dermal invasion is important. Complete excision is the recommended treatment. Adjunctive treatment with topical 5-fluorouracil may be appropriate in some circumstances. Long-term follow up is mandatory.