Buccal mucosal graft after posterior lamellar resection for eyelid sebaceous carcinoma

To evaluate outcomes of single-stage posterior lamellar reconstruction using buccal mucosal grafts after posterior lamellar resection (PLR) for eyelid sebaceous carcinoma.

Retrospective consecutive case series at an academic center (2020-2025). Patients with histopathologically confirmed sebaceous carcinoma who underwent PLR with immediate buccal mucosal grafting, without other posterior lamellar substitutes, were included. Outcomes included graft integration, eyelid position, ocular surface morbidity, complications, and change in visual acuity (VA).

Thirteen eyelids in 12 patients were included (mean age 72.1 ± 10.3 years; 61.5% female). Tumors involved the upper eyelid in nine cases (69.2%) and lower eyelid in four (30.8%). Pagetoid spread was present in 10/11 cases with available data (90.9%). All patients underwent conjunctival cryotherapy following PLR. Grafts were harvested from lip mucosa in 12 cases (92.3%) and cheek mucosa in 1 (7.7%), with mean graft area 946.9 ± 448.5 mm² (range 300-1600). Graft integration was successful in 100%. No entropion, ectropion, or new ptosis occurred; lower-lid retraction occurred in one case (7.7%), mild lagophthalmos in two (15.4%). Ocular surface morbidity included neurotrophic keratopathy in three cases (23.1%) and limbal stem cell deficiency in three (23.1%); two (15.4%) required permanent lateral tarsorrhaphy and one underwent evisceration (7.7%). Among nine eyes with paired data, three (33.3%) lost > three Snellen lines. No local recurrence or distant metastasis occurred during follow-up.

Buccal mucosal grafting provided reliable single-stage posterior lamellar reconstruction after PLR with complete graft integration and generally stable eyelid position; morbidity was driven primarily by ocular surface disease, supporting proactive corneal protection.