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Pagetoid tumour spread in periocular sebaceous gland carcinoma: a comparative analysis in 130 patients
Swathi Kaliki1, Ashi Morawala2, Richa S Dharap2
1Operation Eyesight Universal Institute for Eye Cancer, L V Prasad Eye Institute, Hyderabad, India. kalikiswathi@yahoo.com.
Purpose:
To compare the clinical features, histopathology features, treatment, and prognosis of patients with and without pagetoid tumour spread secondary to periocular sebaceous gland carcinoma (SGC).
Methods:
Retrospective study of 130 patients with SGC who underwent conjunctival map biopsy.
Results:
Of the 130 patients with SGC, 30 (23%) patients had histopathology proven pagetoid tumour spread. On multivariate analysis, increasing tumour basal diameter (p < 0.001) was predictive of pagetoid tumour spread. The odds ratio for tumour basal diameter in prediction of map biopsy positivity for pagetoid tumour spread was 1.13 (95% CI, 1.07-1.19). The sensitivity and specificity of clinicopathological correlation of pagetoid tumour spread was 57 and 90%. Overall, globe salvage was better in those without pagetoid tumour spread compared to those with pagetoid tumour spread (95% vs 33%; p < 0.0001). Comparing those with pagetoid tumour spread vs those without, the 5-year Kaplan-Meier estimate of systemic metastasis was 21% vs 4% (p = 0.15) and death was 28% vs 4% (p = 0.21), respectively.
Conclusion:
Increasing tumour basal diameter can predict the risk of pagetoid tumour spread. Every mm increase in tumour basal diameter increases the risk of pagetoid tumour spread by 13%. Map biopsy is recommended for all patients with periocular SGC's. Though the globe salvage rates are poor in those with pagetoid tumour spread, the occurrence of systemic metastasis and death are not significantly higher compared to those without pagetoid tumour spread.
