Certain suspicious features seen on biopsy indicate eyelid basal cell carcinoma

The presence of madarosis, ulceration, and/or telangiectasia in an incisional eyelid biopsy is strongly predictive of a case of eyelid basal cell carcinoma (BCC).

Study design

This was a retrospective review of histopathologic diagnoses from 179 patients who underwent incisional biopsies for eyelid lesions. Investigators evaluated these diagnoses to determine if the presence of madarosis, ulceration, and telangiectasia had positive predictive values (PPVs) for eyelid BCC.

Outcomes

Seventy-nine of the 179 patients were diagnosed with eyelid BCC. Of these patients, 96% had ulceration, 95% had madarosis, and 75% had telangiectasias over the lid lesion. Each clinical feature was significantly associated with a diagnosis of BCC, and the presence of ≥2 signs in a patient was strongly predictive (100% PPV; odds ratios 3372.33 for ≥2 signs and 483.26 for all 3 signs).

Limitations

This small retrospective review had a potential selection bias, in that all lesions suspicious of malignancy underwent biopsy. While in some cases there is an expectation of concurrent neoplasm, there was no histopathologic presence of other carcinomas present in these biopsies.

Clinical significance

The presence of ≥2 of the aforementioned features is strongly predictive of BCC, and therefore ophthalmologists may consider surgical excision without needing the historically prerequisite incisional biopsy.

Financial Disclosures: Dr. Nikisha Richards discloses financial relationships with Horizon Therapeutics (Consultant/Advisor).