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Table 1 Nordic consensus for treating sebaceous carcinoma of the eyelid

From: Nordic treatment practices survey and consensus for treatment of eyelid sebaceous carcinoma

PracticeStatementReferences
Preoperative work-up
 BiopsyA full thickness or in minimum incisional biopsy, request histological analysis for sebaceous cancer.[13]
 Biopsy in chalazion surgeryRequest histological analysis, when the lesion is clinically suspicious or recurrent.[13]
 Preoperative conjunctival mapping biopsiesConsider, if there is suspected conjunctival involvement.[1, 13, 19,20,21]
 Regional lymph node scanningOffer for category T2b (AJCC 7-th edition) or T2c (AJCC 8th- edition) and worse.[8, 13, 18]
 ColonoscopyShould preferably be offered for all patients with sebaceous cancer. 1)[18, 22]
 A genetic counseling for Muir-Torre syndromeShould preferably be offered if:
• two or more primary sebaceous tumours in one patient and/or
• under 60 years old and history of another MTS or Lynch cancer (colon, rectum, endometrial, ovarian, small bowel, gastric, urinary tract and brain) and/or
• under 60 years old and at least one first degree relative with a tumour above. 2)
[24]
Treatment
 Primary treatment methodSurgery with posterior lamellar resection.[25, 26]
 Clinical marginAt least 4–5 mm. 3)[6, 10, 13, 38,39,40,41,42,43]
 Method of surgeryMulti-stage resection with delayed closure, frozen sections or Mohs surgery are recommended to verify tumour-free margins. Conjunctival mapping biopsies can be performed together with the final surgery if performed as multi-stage resection with delayed closure.[6,7,8, 12, 13, 20, 27,28,29,30,31,32,33,34,35,36,37]
 Sentinel lymph node biopsiesSLNB could be considered for tumours larger than 10 mm.[15, 18, 30, 44,45,46,47,48,49,50]
 PET/CTPET/CT could be considered in the initial staging.[56]
 CryoIn cases with pagetoid spread, additional cryotherapy to the remaining conjunctiva is optional. The primary treatment is local resection if possible without extensive conjunctival resection.[13, 14, 19, 46, 53]
 Mitomycin-CIn cases with extensive conjunctival epithelial spread or residual conjunctival disease, topical Mitomycin- C could be considered as an alternative to extensive surgery or exenteration. If there is growth deep to the epithelium, Mitomycin-C is not an option.[6, 8, 46, 49, 51]
 Postoperative adjuvant radiationOffer radiation for tumors staged T3 (AJCC 7-th edition) or more and in cases with perineural spread or insufficient margins. For patients who deny surgery, radiation at a sufficient dose could be considered.[8, 13, 30, 46, 49, 52, 53]
 Preoperative chemoreductionIn selected cases preoperative chemoreduction can be considered.[54, 55]
Follow-up
 The length of the follow-upIn minimum 5 years. 4)[6,7,8, 11, 26, 41, 46, 57,58,59, 61]
Clinical follow-up intervalFollow-up interval is individual and depends on the post-diagnosis time-frame. In most cases four to 6 months follow-up interval can be considered.
 Follow-up examinationsThe follow-up should in minimum comprise a clinical examination and palpation for lymph nodes. Patients should also be instructed to palpate the lymph nodes themselves in-between follow-ups. Annual scanning (ultrasound or MRI) for regional lymph node metastases is recommended. Scanning for distant metastases could be considered for category T2b (AJCC 7-th edition) or T2c (AJCC 8-th edition) or worse.[8, 15, 46, 48, 58]
  1. Areas of disagreement
  2. 1) Some authors categorically recommended colonoscopy
  3. 2) Some authors categorically recommended Muir - Torre screening in the above defined cases
  4. 3) Some authors recommended a minimum margin of 4 mm and some 5 mm
  5. 4) Some authors recommended a follow-up period of 10 years
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