Risk factors for local recurrence and metastasis of eyelid sebaceous carcinoma after complete excision: A large cohort study in Japan

PURPOSE: To assess risk factors for local recurrence and metastasis in eyelid sebaceous carcinoma after complete excision in a Japanese population. METHODS: In this retrospective study, we reviewed the medical records of 171 Japanese patients with histologically complete eyelid sebaceous carcinoma excision between December 2006 and August 2024. Patients who received adjuvant therapy other than surgery, did not have metastasis screening, or had metastasis detected prior to surgery were excluded. Sebaceous carcinomas were staged according to the American Joint Committee on Cancer staging system, 8 th edition. Kaplan-Meier analysis and the log-rank test were used to determine the risk factors for local recurrence and metastasis. The risk factors and the survival rate for local recurrence and metastasis were then assessed. RESULTS: A total of 147 cases were included. Female sex ( P = 0.024) and pagetoid spread ( P = 0.006) were significantly associated with local recurrence. T stage ≥T1c ( P = 0.041), lower eyelid tumor site ( P = 0.021), and pagetoid spread ( P = 0.011) were significantly associated with metastasis. At 5 years postoperatively, the local recurrence-free survival rate was 93.5% (95% CI: 86.9-96.9) and the metastasis-free survival rate was 89.6% (95% CI: 82.0-94.2). CONCLUSION: Excision margins, and follow-up and surveillance protocols for sebaceous carcinoma may need to reflect the significantly greater risk of local recurrence and metastasis with pagetoid spread, female sex, T stage (worse than T1b), and tumor location on the lower eyelid.