Primary mucinous carcinoma of the eyelid: a clinicopathologic and immunohistochemical study of 4 cases and an update on recurrence rates.

OBJECTIVES To report 4 cases of primary mucinous carcinoma of the eyelid, demonstrate how p63 expression aids diagnosis, and review the literature regarding the local recurrence potential of these eyelid tumors. METHODS Since 1991, we have examined 4 cases of primary mucinous carcinoma of the eyelid. Histology slides were reviewed and clinical information was obtained from the medical records. Published cases of primary mucinous carcinoma involving the eyelid were identified using Ovid MEDLINE and PubMed and references within the articles. RESULTS Our average patient age was 73 years, the female:male ratio was 3:1, and patients had a painless nodular mass for 1 month to 2 years. No patient had another documented malignant tumor at the time of diagnosis. All tumors were dermis based in the upper eyelid, three-fourths invaded the orbicularis oculi muscle, and the average tumor diameter was 3.7 mm. All tumors expressed cytokeratin 7 and gross cystic disease fluid protein 15 and were negative for cytokeratin 20 expression. Tumors demonstrated p63 immunopositivity either focally in the invasive component or peripherally along the in situ component. No recurrences have been evident after an average follow-up of 52 months. Published cases occurring in the eyelid have had a 30% to 40% recurrence rate using surgery without intraoperative evaluation of surgical margins and a 7% recurrence rate after either Mohs surgery or excision with frozen section control. CONCLUSION Primary mucinous carcinoma of the eyelid is a low-grade malignant tumor with the potential for recurrence, although this may be reduced using Mohs surgery or excision with frozen section control.