title: Periocular Squamous Cell Carcinoma: TNM Staging and Recurrence.
abstract: OBJECTIVE
  To analyze the TNM stage, management, and recurrence rates of patients with histologically confirmed squamous cell carcinoma (SCC) of the eyelid.
  
  
  METHODS
  Retrospective case series from 3 Australian centers.
  
  
  METHODS
  A total of 254 cases of eyelid SCC from 254 patients (median age, 73 years; range, 28-102 years; 159 were male).
  
  
  METHODS
  Tumors were staged according to The American Joint Committee on Cancer 7th edition TNM criteria for eyelid carcinoma.
  
  
  METHODS
  Outcomes and recurrence rates according to TNM stage at presentation.
  
  
  RESULTS
  A total of 25 cases (9.8%) were recurrent tumors. TNM classifications were as follows: T1N0M0, 74 patients (29.1%); T2aN0M0, 92 patients (36.2%); T2bN0M0, 50 patients (19.7%); T3aN0M0, 31 patients (12.2%); T3bN0M0, 5 patients (2.0%); T2bN0M1, 1 patient (0.4%); and T3bN1M1, 1 patient (0.4%). Perineural invasion (PNI) was present histologically in 8.3% of cases. Treatment modalities included Mohs microsurgery (31.1%), wide local excision (WLE) with paraffin section control (21.7%), WLE with frozen-section control (19.3%), and excision without margin control (24.4%). Three cases did not receive treatment. Median follow-up was 40 months (range, <1-132 months). Local recurrence occurred in 17 treated patients (6.8%). The recurrence rate was 5.3% (12/226 patients) for primary tumors and 20% (5/25 patients) for recurrent tumors (P = 0.019). Four patients (1.6%) died of their disease during follow-up. Higher T stage was significantly associated with both PNI (P = 0.035) and local recurrence (P < 0.001). We could not identify a T-stage threshold below which there was no risk of recurrence, as evidenced by 3 T1 primary tumors that recurred.
  
  
  CONCLUSIONS
  Higher T stage was significantly associated with local recurrence, and recurrent tumors had a 4-fold increased risk of further recurrence compared with primary tumors. Therefore, it may be reasonable to consider sentinel lymph node biopsy or close nodal surveillance and follow-up for patients with recurrent or high T-stage tumors. Of note, we could not identify a T-stage threshold below which there was no risk of recurrences; therefore, clinicians should be aware of the potential for low T-stage tumors to recur.
authors.affiliation: South Australian Institute of Ophthalmology, University of Adelaide, Adelaide, South Australia, Australia. Electronic address: sun.t.michelle@gmail.com.
authors.forename: Michelle T
authors.initials: MT
authors.lastname: Sun
authors.affiliation: South Australian Institute of Ophthalmology, University of Adelaide, Adelaide, South Australia, Australia.
authors.forename: Nicholas H
authors.initials: NH
authors.lastname: Andrew
authors.affiliation: Royal North Shore Hospital, Sydney, New South Wales, Australia.
authors.forename: Brett
authors.initials: B
authors.lastname: O'Donnell
authors.affiliation: Orbital Plastic and Lacrimal Clinic, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia.
authors.forename: Alan
authors.initials: A
authors.lastname: McNab
authors.affiliation: Department of Dermatology, Royal Adelaide Hospital, University of Adelaide, Adelaide, South Australia, Australia.
authors.forename: Shyamala C
authors.initials: SC
authors.lastname: Huilgol
authors.affiliation: South Australian Institute of Ophthalmology, University of Adelaide, Adelaide, South Australia, Australia.
authors.forename: Dinesh
authors.initials: D
authors.lastname: Selva
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019882:Blepharoplasty; D002294:Carcinoma, Squamous Cell / Q000473:pathology* / Q000601:surgery; D005142:Eyelid Neoplasms / Q000473:pathology* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015580:Mohs Surgery; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D012189:Retrospective Studies