Lower eyelid resection and reconstruction following advanced adnexal carcinoma with mixed neuroendocrine features
Abstract
Endocrine mucin-producing sweat gland carcinoma (EMPSGC) is a rare premalignant lesion and precursor to invasive neuroendocrine primary cutaneous mucinous carcinoma (ne-PCMC). Herein, we report an atypical presentation of ne-PCMC of the lower eyelid managed with en bloc resection and immediate reconstruction. A 56-year-old man presented with a 3×4×4 cm pedunculated, ulcerated right lower eyelid mass that had enlarged over several years despite two prior interventions by dermatology. Although deemed a poor surgical candidate due to his history of chronic kidney disease, chronic obstructive pulmonary disease, poorly controlled type 2 diabetes mellitus, and smoking, he elected to proceed for definitive management. The lesion was excised en bloc under general anesthesia, resulting in a full-thickness defect involving approximately one-third to half of the lower eyelid. Frozen sections were then obtained demonstrating negative margins allowing reconstruction to proceed. A septal mucocartilaginous graft was secured to adjacent eyelid structures for posterior lamellar support. A Mustardé-type cheek rotational flap was designed, elevated in the subcutaneous plane, and rotated medially to close the defect and provide vascularized anterior lamella coverage. The flap was inset with layered closure followed by temporary tarsorrhaphy. Final pathology confirmed invasive, moderately differentiated adnexal carcinoma with partial mucinous differentiation arising in association with EMPSGC. The patient was stable at discharge. At two-week follow-up, the flap was viable, with expected edema, no evidence of infection, and removal of the temporary tarsorrhaphy stitch. Further postoperative follow-up was limited due to recurrent hospitalizations for unrelated comorbid conditions. Most EMPSGC and ne-PCMC are managed with Mohs surgery or standard excision; however, treatment becomes high risk in patients with significant comorbidities and lesions in sensitive areas. This case highlights an unusual presentation requiring complex reconstruction and demonstrates the utility of a Mustardé-type flap in reconstruction of lower eyelid defects.
Start Time
15-4-2026 9:00 AM
End Time
15-4-2026 12:00 PM
Room Number
Culp Ballroom 316
Poster Number
35
Presentation Type
Poster
Presentation Subtype
Posters - Competitive
Presentation Category
Health
Student Type
Graduate and Professional Degree Students, Residents, Fellows
Faculty Mentor
Jeremy Powers
Lower eyelid resection and reconstruction following advanced adnexal carcinoma with mixed neuroendocrine features
Culp Ballroom 316
Endocrine mucin-producing sweat gland carcinoma (EMPSGC) is a rare premalignant lesion and precursor to invasive neuroendocrine primary cutaneous mucinous carcinoma (ne-PCMC). Herein, we report an atypical presentation of ne-PCMC of the lower eyelid managed with en bloc resection and immediate reconstruction. A 56-year-old man presented with a 3×4×4 cm pedunculated, ulcerated right lower eyelid mass that had enlarged over several years despite two prior interventions by dermatology. Although deemed a poor surgical candidate due to his history of chronic kidney disease, chronic obstructive pulmonary disease, poorly controlled type 2 diabetes mellitus, and smoking, he elected to proceed for definitive management. The lesion was excised en bloc under general anesthesia, resulting in a full-thickness defect involving approximately one-third to half of the lower eyelid. Frozen sections were then obtained demonstrating negative margins allowing reconstruction to proceed. A septal mucocartilaginous graft was secured to adjacent eyelid structures for posterior lamellar support. A Mustardé-type cheek rotational flap was designed, elevated in the subcutaneous plane, and rotated medially to close the defect and provide vascularized anterior lamella coverage. The flap was inset with layered closure followed by temporary tarsorrhaphy. Final pathology confirmed invasive, moderately differentiated adnexal carcinoma with partial mucinous differentiation arising in association with EMPSGC. The patient was stable at discharge. At two-week follow-up, the flap was viable, with expected edema, no evidence of infection, and removal of the temporary tarsorrhaphy stitch. Further postoperative follow-up was limited due to recurrent hospitalizations for unrelated comorbid conditions. Most EMPSGC and ne-PCMC are managed with Mohs surgery or standard excision; however, treatment becomes high risk in patients with significant comorbidities and lesions in sensitive areas. This case highlights an unusual presentation requiring complex reconstruction and demonstrates the utility of a Mustardé-type flap in reconstruction of lower eyelid defects.
