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Mohs Surgery for Periocular Malignancies

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Abstract

Mohs micrographic surgery is a technique that enables complete evaluation of the surgical margin in cutaneous tumors. This specialized technique was developed for tumors of the head and neck and is exceptionally important in the treatment of periocular tumors. The most common indications for periocular Mohs surgery include basal cell carcinoma, squamous cell carcinoma, melanoma, sebaceous carcinoma, Merkel cell carcinoma, and other skin malignancies where tissue preservation and clear surgical margins are paramount.

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References

  1. Abide JM, Nahai F, Bennett RG. The meaning of surgical margins. Plast Reconstr Surg. 1984;73(3):492–7. http://www.ncbi.nlm.nih.gov/pubmed/6701225

    Article  CAS  PubMed  Google Scholar 

  2. Rapini RP. Comparison of methods for checking surgical margins. J Am Acad Dermatol. 1990;23(2):288–94. https://doi.org/10.1016/0190-9622(90)70212-Z.

    Article  CAS  PubMed  Google Scholar 

  3. Connolly SM, Baker DR, Coldiron BM, et al. AAD/ACMS/ASDSA/ASMS 2012 appropriate use criteria for Mohs micrographic surgery: a report of the American academy of dermatology, American college of Mohs surgery, American society for dermatologic surgery association, and the American society for Mohs su. Dermatologic Surg. 2012;38(10):1582–603. https://doi.org/10.1111/j.1524-4725.2012.02574.x.

    Article  CAS  Google Scholar 

  4. Moul DK, Chern PL, Shumaker PR, Zelac DE, Greenway HT. Mohs micrographic surgery for eyelid and periorbital skin cancer. Int Ophthalmol Clin. 2009;49(4):111–27. https://doi.org/10.1097/iio.0b013e3181b80482.

    Article  PubMed  Google Scholar 

  5. Thosani MK, Schneck G, Jones EC. Periocular squamous cell carcinoma. Dermatologic Surg. 2008;34(5):585–99. https://doi.org/10.1111/j.1524-4725.2007.34115.x.

    Article  CAS  Google Scholar 

  6. Cook BE, Bartley GB. Treatment options and future prospects for the management of eyelid malignancies. Ophthalmology. 2001;108(11):2088–98.

    Article  PubMed  Google Scholar 

  7. Michelotti B, Mathis R, Roberts J, Travelute C, Billingsley E, Wilkinson M. Periorbital Mohs reconstruction: characterization of tumor histology, anatomic location, and factors influencing postoperative complications. Dermatologic Surg. 2014;40(10):1084–93. https://doi.org/10.1097/DSS.0000000000000125.

    Article  CAS  Google Scholar 

  8. Fujii K, Miyashita T. Gorlin syndrome (nevoid basal cell carcinoma syndrome): update and literature review. Pediatr Int. 2014; https://doi.org/10.1111/ped.12461.

  9. Hahn H, Wicking C, Zaphiropoulos PG, et al. Mutations of the human homolog of drosophila patched in the nevoid basal cell carcinoma syndrome. Cell. 1996. https://doi.org/10.1016/S0092-8674(00)81268-4.

  10. Johnson RL, Rothman AL, Xie J, et al. Human homolog of patched, a candidate gene for the basal cell nevus syndrome. Science (80- ). 1996. https://doi.org/10.1126/science.272.5268.1668.

  11. Bolognia J, Jorizzo J, Schaffer J. Dermatology. 3rd ed. London: Elsevier; 2012.

    Google Scholar 

  12. Wong VA, Marshall JA, Whitehead KJ, Williamson RM, Sullivan TJ. Management of periocular basal cell carcinoma with modified en face frozen section controlled excision. Ophthal Plast Reconstr Surg. 2002;18(6):430–5. https://doi.org/10.1097/00002341-200211000-00008.

    Article  PubMed  Google Scholar 

  13. Mohs F. Micrographic surgery for the microscopically controlled excision of eyelid cancer: history and development. Adv Ophthalmic Plast Reconstr Surg. 1986;5:381–408.

    CAS  PubMed  Google Scholar 

  14. Quinn AG. Ultraviolet radiation and skin carcinogenesis. Br J Hosp Med. 1997;58(6):261–4.

    CAS  PubMed  Google Scholar 

  15. Mohs F. Chemosurgical treatment of cancer of the extremities and trunk; a microscopically controlled method of excision. Arch Surg. 1948; https://doi.org/10.1001/archsurg.1948.01240020828005.

  16. Slutsky JB, Jones EC. Periocular cutaneous malignancies: a review of the literature. Dermatol Surg. 2012;38(4):552–69. https://doi.org/10.1111/j.1524-4725.2012.02367.x.

    Article  CAS  PubMed  Google Scholar 

  17. Malhotra R, Huilgol SC, Huynh NT, Selva D. The Australian Mohs database, part II: periocular basal cell carcinoma outcome at 5-year follow-up. Ophthalmology. 2004;111(4):631–6. https://doi.org/10.1016/j.ophtha.2003.11.004.

    Article  PubMed  Google Scholar 

  18. O’Halloran L, Smith H, Vinciullo C. Periocular Mohs micrographic surgery in Western Australia 2009–2012: a single Centre retrospective review and proposal for practice benchmarks. Australas J Dermatol. 2017;58(2):106–10. https://doi.org/10.1111/ajd.12432.

    Article  PubMed  Google Scholar 

  19. Monheit GD, Callahan MA, Callahan A. Mohs micrographic surgery for periorbital skin cancer. Dermatol Clin. 1989;7(4):677–97. http://www.ncbi.nlm.nih.gov/pubmed/2791356

    Article  CAS  PubMed  Google Scholar 

  20. Litwin AS, Rytina E, Ha T, René C, Woodruff SA. Management of periocular basal cell carcinoma by Mohs micrographic surgery. J Dermatolog Treat. 2013;24(3):232–4. https://doi.org/10.3109/09546634.2012.690506.

    Article  PubMed  Google Scholar 

  21. Rowe DE, Carrol RJ, Day CL. Mohs surgery is the treatment of choice for recurrent (previously treated) basal cell carcinoma. J Dermatol Surg Oncol. 1989;15(4):424–31. https://doi.org/10.1111/j.1524-4725.1989.tb03249.x.

    Article  CAS  PubMed  Google Scholar 

  22. Sin CW, Barua A, Cook A. Recurrence rates of periocular basal cell carcinoma following Mohs micrographic surgery: a retrospective study. Int J Dermatol. 2016;55(9):1044–7. https://doi.org/10.1111/ijd.13326.

    Article  PubMed  Google Scholar 

  23. Thissen MRTM, Neumann MHA, Schouten LJ. A systematic review of treatment modalities for primary basal cell carcinomas. Arch Dermatol. 1999;135(10):1177–83. https://doi.org/10.1001/archderm.135.10.1177.

    Article  CAS  PubMed  Google Scholar 

  24. Nemet AY, Deckel Y, Martin PA, et al. Management of periocular basal and squamous cell carcinoma: a series of 485 cases. Am J Ophthalmol. 2006;142(2):293–7. https://doi.org/10.1016/j.ajo.2006.03.055.

    Article  PubMed  Google Scholar 

  25. Morris DS, Elzaridi E, Clarke L, Dickinson AJ, Lawrence CM. Periocular basal cell carcinoma: 5-year outcome following slow Mohs surgery with formalin-fixed paraffin-embedded sections and delayed closure. Br J Ophthalmol. 2009;93(4):474–6. https://doi.org/10.1136/bjo.2008.141325.

    Article  CAS  PubMed  Google Scholar 

  26. Tildsley J, Diaper C, Herd R. Mohs surgery vs primary excision for eyelid BCCs. Orbit. 2010;29(3):140–5. https://doi.org/10.3109/01676830903421218.

    Article  PubMed  Google Scholar 

  27. Glatt HJ, Olson JJ, Putterman AM. Conventional frozen sections in periocular basal-cell carcinoma: a review of 236 cases. Ophthalmic Surg. 1992;23(1):6–8. discussion 9

    CAS  PubMed  Google Scholar 

  28. Swanson NA. Mohs surgery: technique, indications, applications, and the future. Arch Dermatol. 1983. https://doi.org/10.1001/archderm.119.9.761.

  29. Mosterd K, Krekels GA, Nieman FH, et al. Surgical excision versus Mohs’ micrographic surgery for primary and recurrent basal-cell carcinoma of the face: a prospective randomised controlled trial with 5-years’ follow-up. Lancet Oncol. 2008;9(12):1149–56. https://doi.org/10.1016/S1470-2045(08)70260-2.

    Article  PubMed  Google Scholar 

  30. Leibovitch I, McNab A, Sullivan T, Davis G, Selva D. Orbital invasion by periocular basal cell carcinoma. Ophthalmology. 2005;112(4):717–23. https://doi.org/10.1016/j.ophtha.2004.11.036.

    Article  PubMed  Google Scholar 

  31. Lindgren G, Lindblom B, Larko O. Mohs’ micrographic surgery for basal cell carcinomas on the eyelids and medial canthal area. II. Reconstruction and follow-up. Acta Ophthalmol Scand. 2003;78(4):430–6. https://doi.org/10.1034/j.1600-0420.2000.078004430.x.

    Article  Google Scholar 

  32. Tierney EP, Hanke CW. Cost effectiveness of Mohs micrographic surgery: review of the literature. J Drugs Dermatol. 2009;8(10):914–22.

    PubMed  Google Scholar 

  33. Seidler AM, Bramlette TB, Washington CV, Szeto H, Chen SC. Mohs versus traditional surgical excision for facial and auricular nonmelanoma skin cancer: an analysis of cost-effectiveness. Dermatol Surg. 2009;35(11):1776–87. https://doi.org/10.1111/j.1524-4725.2009.01291.x.

    Article  CAS  PubMed  Google Scholar 

  34. Rogers HW, Coldiron BM. A relative value unit-based cost comparison of treatment modalities for nonmelanoma skin cancer: effect of the loss of the Mohs multiple surgery reduction exemption. J Am Acad Dermatol. 2009;61(1):96–103. https://doi.org/10.1016/j.jaad.2008.07.047.

    Article  PubMed  Google Scholar 

  35. Bialy TL, Whalen J, Veledar E, et al. Mohs micrographic surgery vs traditional surgical excision. Arch Dermatol. 2004;140(6):736–42. https://doi.org/10.1001/archderm.140.6.736.

    Article  PubMed  Google Scholar 

  36. Cook J, Zitelli JA. Mohs micrographic surgery: a cost analysis. J Am Acad Dermatol. 1998;39(5I):698–703. https://doi.org/10.1016/S0190-9622(98)70041-6.

    Article  CAS  PubMed  Google Scholar 

  37. Harvey JT, Anderson RL. The management of meibomian gland carcinoma. Ophthalmic Surg. 1982;13(1):56–61.

    CAS  PubMed  Google Scholar 

  38. Reifler DM, Hornblass A. Squamous cell carcinoma of the eyelid. Surv Ophthalmol. 1986;30(6):349–65.

    Article  CAS  PubMed  Google Scholar 

  39. Que SKT, Zwald FO, Schmults CD. Cutaneous squamous cell carcinoma: incidence, risk factors, diagnosis, and staging. J Am Acad Dermatol. 2018;78(2):237–47. https://doi.org/10.1016/j.jaad.2017.08.059.

    Article  PubMed  Google Scholar 

  40. Malhotra R, James CL, Selva D, Huynh N, Huilgol SC. The Australian Mohs database: periocular squamous intraepidermal carcinoma. Ophthalmology. 2004;111(10):1925–9. https://doi.org/10.1016/j.ophtha.2004.04.025.

    Article  PubMed  Google Scholar 

  41. Sullivan TJ, Boulton JE, Whitehead KJ. Intraepidermal carcinoma of the eyelid. Clin Exp Ophthalmol. 2002;30(1):23–7.

    Article  PubMed  Google Scholar 

  42. Donaldson MJ, Sullivan TJ, Whitehead KJ, Williamson RM. Squamous cell carcinoma of the eyelids. Br J Ophthalmol. 2002;86(10):1161–5. https://doi.org/10.1136/bjo.86.10.1161.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  43. Weedon D. Weedon’s skin pathology. 3rd ed. London: Elsevier; 2009.

    Google Scholar 

  44. Boynton JR, Searl SS, Caldwell EH. Large periocular keratoacanthoma: the case for definitive treatment. Ophthalmic Surg. 1986;17(9):565–9.

    CAS  PubMed  Google Scholar 

  45. Leibovitch I, Huilgol SC, James CL, Hsuan JD, Davis G, Selva D. Periocular keratoacanthoma: can we always rely on the clinical diagnosis? Br J Ophthalmol. 2005;89(9):1201–4. https://doi.org/10.1136/bjo.2005.072470.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  46. Criscione VD, Weinstock MA, Naylor MF, Luque C, Eide MJ, Bingham SF. Actinic keratoses: natural history and risk of malignant transformation in the veterans affairs topical Tretinoin chemoprevention trial. Cancer. 2009;115(11):2523–30. https://doi.org/10.1002/cncr.24284.

    Article  PubMed  Google Scholar 

  47. Siegel JA, Korgavkar K, Weinstock MA. Current perspective on actinic keratosis: a review. Br J Dermatol. 2017;177(2):350–8. https://doi.org/10.1111/bjd.14852.

    Article  CAS  PubMed  Google Scholar 

  48. Faustina M, Diba R, Ahmadi MA, Gutstein BF, Esmaeli B. Patterns of regional and distant metastasis in patients with eyelid and periocular squamous cell carcinoma. Ophthalmology. 2004;111(10):1930–2. https://doi.org/10.1016/j.ophtha.2004.02.009.

    Article  PubMed  Google Scholar 

  49. Tyers AG. Orbital exenteration for invasive skin tumours. Eye (Lond). 2006;20(10):1165–70. https://doi.org/10.1038/sj.eye.6702380.

    Article  CAS  Google Scholar 

  50. Payne JW, Duke JR, de Butner RE. Basal cell carcinoma of the eyelids - a long term follow-up study. Arch Ophthalmol. 1969;81(4):553–8. papers://346b7a39-b9bf-4d02-9150-a7329d4930bc/Paper/p2021

    Article  CAS  PubMed  Google Scholar 

  51. Migden MR, Rischin D, Schmults CD, et al. PD-1 blockade with Cemiplimab in advanced cutaneous squamous-cell carcinoma. N Engl J Med. 2018;379(4):341–51. https://doi.org/10.1056/NEJMoa1805131.

    Article  CAS  PubMed  Google Scholar 

  52. Malhotra R, Huilgol SC, Huynh NT, Selva D. The Australian Mohs database: periocular squamous cell carcinoma. Ophthalmology. 2004;111(4):617–23. https://doi.org/10.1016/j.ophtha.2003.07.020.

    Article  PubMed  Google Scholar 

  53. Rowe DE, Carroll RJ, Day CLJ. Prognostic factors for local recurrence, metastasis, and survival rates in squamous cell carcinoma of the skin, ear, and lip. Implications for treatment modality selection. J Am Acad Dermatol. 1992;26(6):976–90.

    Article  CAS  PubMed  Google Scholar 

  54. Spencer JM, Nossa R, Tse DT, Sequeira M. Sebaceous carcinoma of the eyelid treated with Mohs micrographic surgery. J Am Acad Dermatol. 2001;44(6):1004–9. https://doi.org/10.1067/mjd.2001.113692.

    Article  CAS  PubMed  Google Scholar 

  55. Nelson BR, Renee Hamlet K, Gillard M, Railan D, Johnson TM, Arbor A. Sebaceous carcinoma. J Am Acad Dermatol. 1995;33. https://www.jaad.org/article/0190-9622(95)90001-2/pdf.

  56. Honavar SG, Shields CL, Maus M, Shields JA, Demirci H, Eagle RC Jr. Primary intraepithelial sebaceous gland carcinoma of the palpebral conjunctiva. Arch Ophthalmol. 2001;119(5):764–7.

    Article  CAS  PubMed  Google Scholar 

  57. Hou JL, Killian JM, Baum CL, et al. Characteristics of sebaceous carcinoma and early outcomes of treatment using Mohs micrographic surgery versus wide local excision: an update of the Mayo Clinic experience over the past 2 decades. Dermatol Surg. 2014;40(3):241–6. https://doi.org/10.1111/dsu.12433.

    Article  CAS  PubMed  Google Scholar 

  58. Zhou C, Wu F, Chai P, et al. Mohs micrographic surgery for eyelid sebaceous carcinoma: a multicenter cohort of 360 patients. J Am Acad Dermatol. 2019;80(6):1608–1617.e1. https://doi.org/10.1016/j.jaad.2018.12.053.

    Article  PubMed  Google Scholar 

  59. Yoon JS, Kim SH, Lee CS, Lew H, Lee SY. Clinicopathological analysis of periocular sebaceous gland carcinoma. Ophthalmol J Int d’ophtalmologie Int J Ophthalmol Zeitschrift fur Augenheilkd. 2007;221(5):331–9. https://doi.org/10.1159/000104764.

    Article  Google Scholar 

  60. Snow SN, Larson PO, Lucarelli MJ, Lemke BN, Madjar DD. Sebaceous carcinoma of the eyelids treated by Mohs micrographic surgery: report of nine cases with review of the literature. Dermatol Surg. 2002;28(7):623–31.

    PubMed  Google Scholar 

  61. Buitrago W, Joseph AK. Sebaceous carcinoma: the great masquerader: emerging concepts in diagnosis and treatment. Dermatol Ther. 2008;21(6):459–66. https://doi.org/10.1111/j.1529-8019.2008.00247.x.

    Article  PubMed  Google Scholar 

  62. Berlin AL, Amin SP, Goldberg DJ. Extraocular sebaceous carcinoma treated with Mohs micrographic surgery: report of a case and review of literature. Dermatologic Surg. 2008;34(2):254–7. https://doi.org/10.1111/j.1524-4725.2007.34051.x.

    Article  CAS  Google Scholar 

  63. Ratz JL, Luu-Duong S, Kulwin DR. Sebaceous carcinoma of the eyelid treated with Mohs’ surgery. J Am Acad Dermatol. 1986;14(4):668–73.

    Article  CAS  PubMed  Google Scholar 

  64. Thomas CJ, Wood GC, Marks VJ. Mohs micrographic surgery in the treatment of rare aggressive cutaneous tumors: the Geisinger experience. Dermatol Surg. 2007;33(3):333–9. https://doi.org/10.1111/j.1524-4725.2007.33069.x.

    Article  CAS  PubMed  Google Scholar 

  65. Dzubow LM. Sebaceous carcinoma of the eyelid: treatment with Mohs surgery. I Dermatol Surg Oncol. 1985;11:40–4.

    Article  CAS  Google Scholar 

  66. Shields JA, Demirci H, Marr BP, Eagle RC, Shields CL. Sebaceous carcinoma of the ocular region: a review. Surv Ophthalmol. 2005;50(2):103–22. https://doi.org/10.1016/j.survophthal.2004.12.008.

    Article  PubMed  Google Scholar 

  67. Eisen DB, Michael DJ. Sebaceous lesions and their associated syndromes: part I. J Am Acad Dermatol. 2009;61(4):542–9. https://doi.org/10.1016/j.jaad.2009.04.058.

    Article  Google Scholar 

  68. Eisen DB, Michael DJ. Sebaceous lesions and their associated syndromes: part II. J Am Acad Dermatol. 2009;61(4):563–80. https://doi.org/10.1016/j.jaad.2009.04.059.

    Article  PubMed  Google Scholar 

  69. Skalicky SE, Holt PE, Giblin M, Taylor S, Conway RM. Australian Cancer network clinical practice guidelines for the management of ocular and periocular melanoma: an evidence-based literature analysis. Clin Exp Ophthalmol. 2008;36(7):646–58. https://doi.org/10.1111/j.1442-9071.2008.01815.x.

    Article  PubMed  Google Scholar 

  70. Vaziri M, Buffam FV, Martinka M, Oryschak A, Dhaliwal H, White VA. Clinicopathologic features and behavior of cutaneous eyelid melanoma. Ophthalmology. 2002;109(5):901–8.

    Article  PubMed  Google Scholar 

  71. Mirzoyev SA, Knudson RM, Reed KB, et al. Incidence of lentigo maligna in Olmsted County, Minnesota, 1970 to 2007. J Am Acad Dermatol. 2014;70(3):443–8. https://doi.org/10.1016/j.jaad.2013.11.008.

    Article  PubMed  Google Scholar 

  72. Shumaker PR, Kelley B, Swann MH, Greenway HTJ. Modified Mohs micrographic surgery for periocular melanoma and melanoma in situ: long-term experience at Scripps clinic. Dermatol Surg. 2009;35(8):1263–70. https://doi.org/10.1111/j.1524-4725.2009.01222.x.

    Article  CAS  PubMed  Google Scholar 

  73. Chan FM, O’Donnell BA, Whitehead K, Ryman W, Sullivan TJ. Treatment and outcomes of malignant melanoma of the eyelid: a review of 29 cases in Australia. Ophthalmology. 2007;114(1):187–92. https://doi.org/10.1016/j.ophtha.2006.08.043.

    Article  PubMed  Google Scholar 

  74. Leachman SA, Cassidy PB, Chen SC, et al. Methods of melanoma detection. Cancer Treat Res. 2016;167:51–105. https://doi.org/10.1007/978-3-319-22539-5_3.

    Article  PubMed  Google Scholar 

  75. Nosrati A, Berliner JG, Goel S, et al. Outcomes of melanoma in situ treated with Mohs micrographic surgery compared with wide local excision. JAMA Dermatol. 2017;153(5):436–41. https://doi.org/10.1001/jamadermatol.2016.6138.

    Article  PubMed  PubMed Central  Google Scholar 

  76. Ellison PM, Zitelli JA, Brodland DG. Mohs surgery for melanoma; a prospective multicenter study. J Am Acad Dermatol. May 2019. https://doi.org/10.1016/j.jaad.2019.05.057.

  77. Rzepecki AK, Hwang CD, Etzkorn JR, et al. The “Rule of 10s” versus the “Rule of 2s”: High complication rates after conventional excision with postoperative margin assessment of specialty site versus trunk and proximal extremity melanomas. J Am Acad Dermatol. November 2018. https://doi.org/10.1016/j.jaad.2018.11.008.

  78. Cohen LM. Lentigo maligna and lentigo maligna melanoma. J Am Acad Dermatol. 1995;33(6):923–40.

    Article  CAS  PubMed  Google Scholar 

  79. Etzkorn JR, Jew OS, Shin TM, Sobanko JF, Neal DE, Miller CJ. Mohs micrographic surgery with melanoma antigen recognized by T cells 1 (MART-1) immunostaining for atypical intraepidermal melanocytic proliferation. J Am Acad Dermatol. 2018;79(6):1109–1116.e1. https://doi.org/10.1016/j.jaad.2018.06.058.

    Article  PubMed  Google Scholar 

  80. Moyer JS, Rudy S, Boonstra PS, et al. Efficacy of staged excision with permanent section margin control for cutaneous head and neck melanoma. JAMA Dermatol. 2017;153(3):282–8. https://doi.org/10.1001/jamadermatol.2016.4603.

    Article  PubMed  Google Scholar 

  81. Zalaudek I, Horn M, Richtig E, Hodl S, Kerl H, Smolle J. Local recurrence in melanoma in situ: influence of sex, age, site of involvement and therapeutic modalities. Br J Dermatol. 2003;148(4):703–8. https://doi.org/10.1046/j.1365-2133.2003.05155.x.

    Article  CAS  PubMed  Google Scholar 

  82. Park AJ, Paul J, Chapman MS, Samie FH. Long-term outcomes of melanoma in situ treated with topical 5% imiquimod cream: a retrospective review. Dermatol Surg. 2017;43(8):1017–22. https://doi.org/10.1097/DSS.0000000000001115.

    Article  CAS  PubMed  Google Scholar 

  83. Mora AN, Karia PS, Nguyen BM. A quantitative systematic review of the efficacy of imiquimod monotherapy for lentigo maligna and an analysis of factors that affect tumor clearance. J Am Acad Dermatol. 2015;73(2):205–12. https://doi.org/10.1016/j.jaad.2015.05.022.

    Article  CAS  PubMed  Google Scholar 

  84. Swetter SM, Chen FW, Kim DD, Egbert BM. Imiquimod 5% cream as primary or adjuvant therapy for melanoma in situ, lentigo maligna type. J Am Acad Dermatol. 2015;72(6):1047–53. https://doi.org/10.1016/j.jaad.2015.02.008.

    Article  CAS  PubMed  Google Scholar 

  85. Hong A, Fogarty G. Role of radiation therapy in cutaneous melanoma. Cancer J. 2012;18(2):203–7. https://doi.org/10.1097/PPO.0b013e31824b241a.

    Article  PubMed  Google Scholar 

  86. Schmid-Wendtner MH, Brunner B, Konz B, et al. Fractionated radiotherapy of lentigo maligna and lentigo maligna melanoma in 64 patients. J Am Acad Dermatol. 2000;43(3):477–82. https://doi.org/10.1067/mjd.2000.106241.

    Article  CAS  PubMed  Google Scholar 

  87. Farshad A, Burg G, Panizzon R, Dummer R. A retrospective study of 150 patients with lentigo maligna and lentigo maligna melanoma and the efficacy of radiotherapy using Grenz or soft X-rays. Br J Dermatol. 2002;146(6):1042–6. https://doi.org/10.1046/j.1365-2133.2002.04750.x.

    Article  CAS  PubMed  Google Scholar 

  88. Missotten GS, de Wolff-Rouendaal D, de Keizer RJW. Merkel cell carcinoma of the eyelid review of the literature and report of patients with Merkel cell carcinoma showing spontaneous regression. Ophthalmology. 2008;115(1):195–201. https://doi.org/10.1016/j.ophtha.2007.02.024.

    Article  PubMed  Google Scholar 

  89. Giacomin AL, di Pietro R, Steindler P. Merkel cell carcinoma: a distinct lesion of the eyelid. Orbit. 1999;18(4):295–303.

    Article  PubMed  Google Scholar 

  90. Peters GB 3rd, Meyer DR, Shields JA, et al. Management and prognosis of Merkel cell carcinoma of the eyelid. Ophthalmology. 2001;108(9):1575–9.

    Article  PubMed  Google Scholar 

  91. Metz KA, Jacob M, Schmidt U, Steuhl KP, Leder LD. Merkel cell carcinoma of the eyelid: histological and immunohistochemical features with special respect to differential diagnosis. Graefes Arch Clin Exp Ophthalmol. 1998;236(8):561–6.

    Article  CAS  PubMed  Google Scholar 

  92. Thakur S, Chalioulias K, Hayes M, While A. Bilateral primary Merkel cell carcinoma of the upper lid misdiagnosed as basal cell carcinoma. Orbit. 2008;27(2):139–41. https://doi.org/10.1080/01676830701556715.

    Article  CAS  PubMed  Google Scholar 

  93. Feng H, Shuda M, Chang Y, Moore PS. Clonal integration of a polyomavirus in human Merkel cell carcinoma. Science. 2008;319(5866):1096–100. https://doi.org/10.1126/science.1152586.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  94. Coggshall K, Tello TL, North JP, Yu SS. Merkel cell carcinoma: an update and review: pathogenesis, diagnosis, and staging. J Am Acad Dermatol. 2018;78(3):433–42. https://doi.org/10.1016/j.jaad.2017.12.001.

    Article  PubMed  Google Scholar 

  95. Stokes JB, Graw KS, Dengel LT, et al. Patients with Merkel cell carcinoma tumors < or = 1.0 cm in diameter are unlikely to harbor regional lymph node metastasis. J Clin Oncol. 2009;27(23):3772–7. https://doi.org/10.1200/JCO.2008.20.8272.

    Article  PubMed  PubMed Central  Google Scholar 

  96. Iyer JG, Storer BE, Paulson KG, et al. Relationships among primary tumor size, number of involved nodes, and survival for 8044 cases of Merkel cell carcinoma. J Am Acad Dermatol. 2014;70(4):637–43. https://doi.org/10.1016/j.jaad.2013.11.031.

    Article  PubMed  PubMed Central  Google Scholar 

  97. Sattler E, Geimer T, Sick I, et al. Sentinel lymph node in Merkel cell carcinoma: to biopsy or not to biopsy? J Dermatol. 2013;40(5):374–9. https://doi.org/10.1111/1346-8138.12072.

    Article  CAS  PubMed  Google Scholar 

  98. Lawenda BD, Arnold MG, Tokarz VA, et al. Analysis of radiation therapy for the control of Merkel cell carcinoma of the head and neck based on 36 cases and a literature review. Ear Nose Throat J. 2008;87(11):634–43.

    Article  PubMed  Google Scholar 

  99. Hasan S, Liu L, Triplet J, Li Z, Mansur D. The role of postoperative radiation and chemoradiation in Merkel cell carcinoma: a systematic review of the literature. Front Oncol. 2013;3:276. https://doi.org/10.3389/fonc.2013.00276.

    Article  PubMed  PubMed Central  Google Scholar 

  100. Goldstein DJ, Barr RJ, Santa Cruz DJ. Microcystic adnexal carcinoma: a distinct clinicopathologic entity. Cancer. 1982;50(3):566–72. https://doi.org/10.1002/1097-0142(19820801)50:3<566::aid-cncr2820500330>3.0.co;2-q.

    Article  CAS  PubMed  Google Scholar 

  101. Kirkland PM, Solomons NB, Ratcliffe NA. Microcystic adnexal carcinoma. J Laryngol Otol. 1997;111(7):674–5. https://doi.org/10.1017/s0022215100138307.

    Article  CAS  PubMed  Google Scholar 

  102. Cooper PH. Sclerosing carcinomas of sweat ducts (microcystic adnexal carcinoma). Arch Dermatol. 1986;122(3):261–4.

    Article  CAS  PubMed  Google Scholar 

  103. Rongioletti F, Grosshans E, Rebora A. Microcystic adnexal carcinoma. Br J Dermatol. 1986;115(1):101–4. https://doi.org/10.1111/j.1365-2133.1986.tb06226.x.

    Article  CAS  PubMed  Google Scholar 

  104. Pujol RM, LeBoit PE, Su WP. Microcystic adnexal carcinoma with extensive sebaceous differentiation. Am J Dermatopathol. 1997;19(4):358–62.

    Article  CAS  PubMed  Google Scholar 

  105. Yu Y, Finn DT, Rogers GS. Microcystic adnexal carcinoma: a rare, locally aggressive cutaneous tumor. Am J Clin Oncol. 2010;33(2):196–7. https://doi.org/10.1097/COC.0b013e318197924c.

    Article  PubMed  Google Scholar 

  106. Gordon S, Fischer C, Martin A, Rosman IS, Council ML. Microcystic adnexal carcinoma: a review of the literature. Dermatol Surg. 2017;43(8):1012–6. https://doi.org/10.1097/DSS.0000000000001142.

    Article  CAS  PubMed  Google Scholar 

  107. Worley B, Owen JL, Barker CA, et al. Evidence-based clinical practice guidelines for microcystic adnexal carcinoma. JAMA Dermatol. 2019;60611 https://doi.org/10.1001/jamadermatol.2019.1251.

  108. Mayer MH, Winton GB, Smith AC, Lupton GP, Parry EL, Shagets FW. Microcystic adnexal carcinoma (sclerosing sweat duct carcinoma). Plast Reconstr Surg. 1989;84(6):970–5. https://doi.org/10.1097/00006534-198912000-00018.

    Article  CAS  PubMed  Google Scholar 

  109. Carroll P, Goldstein GD, Brown CWJ. Metastatic microcystic adnexal carcinoma in an immunocompromised patient. Dermatol Surg. 2000;26(6):531–4.

    Article  CAS  PubMed  Google Scholar 

  110. Leibovitch I, Huilgol SC, Selva D, Lun K, Richards S, Paver R. Microcystic adnexal carcinoma: treatment with Mohs micrographic surgery. J Am Acad Dermatol. 2005;52(2):295–300. https://doi.org/10.1016/j.jaad.2004.10.868.

    Article  PubMed  Google Scholar 

  111. Palamaras I, McKenna JD, Robson A, Barlow RJ. Microcystic adnexal carcinoma: a case series treated with Mohs micrographic surgery and identification of patients in whom paraffin sections may be preferable. Dermatol Surg. 2010;36(4):446–52. https://doi.org/10.1111/j.1524-4725.2010.01476.x.

    Article  CAS  PubMed  Google Scholar 

  112. Chiller K, Passaro D, Scheuller M, Singer M, McCalmont T, Grekin RC. Microcystic adnexal carcinoma: forty-eight cases, their treatment, and their outcome. Arch Dermatol. 2000;136(11):1355–9. https://doi.org/10.1001/archderm.136.11.1355.

    Article  CAS  PubMed  Google Scholar 

  113. Billingsley EM, Fedok F, Maloney ME. Microcystic adnexal carcinoma. Case report and review of the literature. Arch Otolaryngol Head Neck Surg. 1996;122(2):179–82.

    Article  CAS  PubMed  Google Scholar 

  114. Friedman PM, Friedman RH, Jiang SB, Nouri K, Amonette R, Robins P. Microcystic adnexal carcinoma: collaborative series review and update. J Am Acad Dermatol. 1999;41(2 Pt 1):225–31. https://doi.org/10.1016/s0190-9622(99)70053-8.

    Article  CAS  PubMed  Google Scholar 

  115. McKinley LH, Seastrom S, Hanly AJ, Miller RA. Microcystic adnexal carcinoma: review of a potential diagnostic pitfall and management. Cutis. 2014;93(3):162–5.

    PubMed  Google Scholar 

  116. Wick MR, Cooper PH, Swanson PE, Kaye VN, Sun TT. Microcystic adnexal carcinoma. An immunohistochemical comparison with other cutaneous appendage tumors. Arch Dermatol. 1990;126(2):189–94. https://doi.org/10.1001/archderm.126.2.189.

    Article  CAS  PubMed  Google Scholar 

  117. Uchida N, Urano Y, Oura H, et al. Microcystic adnexal carcinoma. Case report with an immunohistochemical study. Dermatology. 1993;187(2):119–23. https://doi.org/10.1159/000247220.

    Article  CAS  PubMed  Google Scholar 

  118. Callahan EF, Vidimos AT, Bergfeld WF. Microcystic adnexal carcinoma (MAC) of the scalp with extensive Pilar differentiation. Dermatol Surg. 2002;28(6):536–9.

    PubMed  Google Scholar 

  119. King BJ, Tolkachjov SN, Winchester DS, et al. Demographics and outcomes of microcystic adnexal carcinoma. J Am Acad Dermatol. 2018;79(4):756–8. https://doi.org/10.1016/j.jaad.2018.03.010.

    Article  PubMed  Google Scholar 

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Overman, J., Leitenberger, J., White, K., Bar, A. (2022). Mohs Surgery for Periocular Malignancies. In: Albert, D.M., Miller, J.W., Azar, D.T., Young, L.H. (eds) Albert and Jakobiec's Principles and Practice of Ophthalmology. Springer, Cham. https://doi.org/10.1007/978-3-030-42634-7_80

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