Abstract Listings 2024

Purpose

To evaluate the accuracy of clinical diagnosis of periocular cutaneous lesions and to assess the need for histopathological analysis in every case of a clinically benign lesion in an oculoplastics minor ops setting.

Methods

We performed a retrospective review of hospital records for consecutive patients presenting with periocular cutaneous lesions to Milton Keynes University Hospital between October 2022 and February 2024, who subsequently underwent biopsy with histopathological evaluation. A clinical diagnosis was provided by a consultant oculoplastic surgeon at the initial visit and lesions were categorised as benign or malignant. Histopathological analysis was correlated to determine the accuracy of the clinical diagnosis (SPSS version 29.0). Patients with conjunctival lesions, previous biopsy or unavailable results were excluded.

Results

136 consecutive patients (age: 63.0 ±16.5 years, 55.1% male) with 145 periocular lesions were included, of which 15.2% were malignant. Patients with histopathologically-confirmed malignant lesions tended to be older (77.4±11.4 vs 60.5±15.9 years, p<0.001), but this did not vary by gender (p=0.356).

Clinical diagnosis had a sensitivity of 86.4%, specificity of 87.0%, positive predictive value 0.54, and negative predictive value 0.97 for detecting malignant eyelid lesions. Three cases clinically diagnosed as benign (papilloma/hydrocystoma) were revealed to be basal cell carcinomas. Of the malignant lesions, the exact clinical and histopathological diagnosis in 90.9% (n=20/22) of cases, all basal cell carcinomas.

There were 123 histopathologically benign lesions – most common were hydrocystoma (28%), papilloma (13.6%), naevus (11%) and epidermoid (11%). 11 lesions suspicious for malignancy clinically were shown benign histopathologically.

Conclusion

Clinical experience to have a moderately high sensitivity and specificity for diagnosing malignant periocular lesions. There is value in obtaining histopathological testing for all excised eyelid lesions, even when clinically benign, to exclude malignancy and optimise patient outcomes.

Additional Authors

↑ Back to top