Application of the AJCC 7th edition carcinoma of the eyelid staging system: a medical center pathology based, 15-year review

Courtney Crawford¹, Colby Fernelius², Paula Young¹, Stephen Groo², Darryl Ainbinder^2
1Blanchfield Army Hospital, Fort Campbell, KY, USA; ²Madigan Army Medical Center, Fort Lewis, WA, USA

Context: The purpose of this study was to conduct a quality improvement (QI), applied practical review of the American Joint Committee on Cancer (AJCC) 7th edition, Carcinoma of the Eyelid staging system. AJCC utilizes a primary tumor, lymph node, metastasis (pTNM) cancer staging approach.
Objective: We wanted to determine if the AJCC pTNM carcinoma staging system identified patients with highly aggressive carcinoma of the eyelid. We also wanted to determine if there were any unexpected issues in its practical application.
Design: We conducted a 15-year, consecutive, retrospective review of all cases of excisional biopsy for carcinoma of the eyelid. We reviewed the original histopathology slides and complete pathology records for each case.
Results: Over a 15-year review period, 52 cases of excisional biopsy for carcinoma of the eyelid were identified. The average age of the study population was 72 years. Nodular well-differentiated basal cell carcinoma (BCC) was the predominant histology for 85% of cases. Morpheaform/metatypical BCC was the next dominant at 9%. Squamous cell carcinoma and sebaceous carcinoma followed at 4% and 2%, respectively. We were able to assign clear staging to 50 of the 52 cases with the available pathology data. The stage results were as follows: stage 1A 72%, stage 1B 22%, stage II 4%, stage III 2%, with no cases of stage IV metastatic disease.
Conclusions: The 7th edition AJCC Carcinoma of the Eyelid chapter proved to be a practical tool for carcinoma staging of the eyelid. The largest tumor dimension remains an effective predictive factor. High-grade pathologic prognostic factors such as tumor necrosis or perineural spread had a 100% association with a final stage of II or greater. Concordance and compliance was 100% for the recommended site-specific pathologic risk factors. Regarding squamous cell carcinoma of the eyelid, three new required data points had a 0% reporting rate over 15 years. Overall, smaller less invasive tumors were classified as stage 1A and 1B tumors. More invasive and higher risk tumors fell into appropriate higher staging classifications. The newly recommended prognostic site-specific tumor factors appear to work well with a high concordance with staging severity, and strong medical community acceptance.

Keywords: eyelid, pathology, oncology