High-Risk Characteristics of Eyelid Basal Cell Carcinoma in Young Patients: A Retrospective Cohort Study

Early-onset eyelid basal cell carcinoma (BCC) is uncommon, and it remains unclear whether younger patients exhibit distinct tumor characteristics, risk-factor profiles, or postoperative outcomes compared with older patients. This retrospective cohort included 268 patients with histologically confirmed eyelid BCC. Patients were stratified by age at surgery (< 40 vs. ≥ 40 years). Demographic risk factors, tumor characteristics, surgical margins, reconstruction, and follow-up outcomes were compared. The primary outcome was crude local recurrence during follow-up. Sequential Firth penalized logistic regression evaluated age < 40 years with adjustment for histological subtype and clinical and surgical characteristics. Of 268 patients enrolled in the study, 45 were aged < 40 years and 223 were ≥ 40 years. Younger patients more often were female (64.4% vs. 43.9%; P = 0.014), reported indoor tanning (35.6% vs. 7.6%; P < 0.001), and had a genetic syndrome (8.9% vs. 0.0%; P < 0.001). Tumors in younger patients more often involved the clinical eyelid margin (64.4% vs. 23.3%; P < 0.001), had involved initial margins (68.9% vs. 35.4%; P < 0.001), and required revision stages (73.3% vs. 17.5%; P < 0.001). Crude local recurrence was higher in younger patients (22.2% vs. 5.8%; P = 0.001), as was documented dry eye syndrome (26.7% vs. 4.0%; P < 0.001). Age < 40 years was associated with increased recurrence risk on unadjusted analysis, but this association attenuated after adjustment for histology and clinical characteristics. Young adults with eyelid BCC showed distinctive exposure patterns, high-risk anatomic/surgical features, and higher crude recurrence. The age–recurrence association attenuated after adjustment, suggesting that age alone may not explain the observed difference. Basal cell carcinoma is the most common eyelid cancer. It usually affects older adults, so less is known about cases in people under 40 years of age. We reviewed 268 patients who had surgery for eyelid basal cell carcinoma and compared 45 patients under 40 years with 223 patients aged 40 years or older. Younger patients were more often women and more often reported indoor tanning use. Their tumors more often involved the eyelid margin, had cancer at the edge of the first excision, and needed additional surgical stages to clear the tumor. Local recurrence during available follow-up was more frequent in younger patients, but the association between younger age and recurrence became weaker after accounting for tumor and surgical features. Younger patients also had more dry eye documented after surgery. These findings support careful margin control, long-term follow-up, counseling about ultraviolet exposure, and attention to ocular surface symptoms in young adults treated for eyelid basal cell carcinoma.