title: Management of perineural invasion in sebaceous carcinoma of the eyelid.
abstract: OBJECTIVE
  To report the occurrence and management of perineural invasion in patients with sebaceous carcinoma of the eyelid.
  
  
  METHODS
  An ophthalmology database was searched for all patients treated for sebaceous carcinoma of the eyelid by the principal investigator between May 1999 and May 2010. The clinical records and pathology specimens of the patients with microscopic perineural invasion as an incidental finding in their eyelid surgical specimen were reviewed.
  
  
  RESULTS
  Forty-two patients with sebaceous carcinoma of the eyelid were treated by the principal investigator during the study period. Three of them had evidence of microscopic perineural invasion in the surgical specimen. Each patient was treated with surgery with or without radiotherapy. The first patient underwent orbital exenteration and negative sentinel lymph node biopsy, subsequently developed distant metastasis, and died 20 months after exenteration. The second patient underwent resection of the tumor and positive sentinel lymph node biopsy, postoperative irradiation of the eyelid, completion neck dissection and parotidectomy for the positive sentinel lymph node, and irradiation of nodal basins; she was free of disease at last follow up (12 months after tumor resection). The third patient underwent resection of the tumor, developed regional lymph node metastasis 3 months later, underwent lymph node dissection and postoperative nodal irradiation, and was free of disease at last follow up (9 months after tumor resection).
  
  
  CONCLUSIONS
  Perineural invasion was encountered in 7% of patients with eyelid sebaceous carcinoma. The authors' preference is to treat patients with an incidental finding of microscopic perineural invasion with postoperative adjuvant radiotherapy, ideally within 4 to 6 weeks after surgical resection of the primary eyelid tumor.
authors.affiliation: Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Connor
authors.forename: Lilly
authors.initials: L
authors.lastname: Droll
authors.forename: Doina
authors.initials: D
authors.lastname: Ivan
authors.forename: Jonathan
authors.initials: J
authors.lastname: Cutlan
authors.forename: Randal S
authors.initials: RS
authors.lastname: Weber
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Frank
authors.forename: Bita
authors.initials: B
authors.lastname: Esmaeli
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000473:pathology / Q000628:therapy; D019468:Disease Management; D005142:Eyelid Neoplasms / Q000473:pathology / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D009361:Neoplasm Invasiveness / Q000473:pathology; D012626:Sebaceous Gland Neoplasms / Q000473:pathology / Q000628:therapy