High-Risk Characteristics of Eyelid Basal Cell Carcinoma in Young Patients: A Retrospective Cohort Study.

INTRODUCTION: Early-onset eyelid basal cell carcinoma (BCC) is uncommon, and it remains unclear whether younger patients exhibit distinct tumor characteristics, risk-factor profiles, or postoperative outcomes compared with older patients. METHODS: This retrospective cohort included 268 patients with histologically confirmed eyelid BCC. Patients were stratified by age at surgery (< 40 vs. ≥ 40 years). Demographic risk factors, tumor characteristics, surgical margins, reconstruction, and follow-up outcomes were compared. The primary outcome was crude local recurrence during follow-up. Sequential Firth penalized logistic regression evaluated age < 40 years with adjustment for histological subtype and clinical and surgical characteristics. RESULTS: Of 268 patients enrolled in the study, 45 were aged < 40 years and 223 were ≥ 40 years. Younger patients more often were female (64.4% vs. 43.9%; P = 0.014), reported indoor tanning (35.6% vs. 7.6%; P < 0.001), and had a genetic syndrome (8.9% vs. 0.0%; P < 0.001). Tumors in younger patients more often involved the clinical eyelid margin (64.4% vs. 23.3%; P < 0.001), had involved initial margins (68.9% vs. 35.4%; P < 0.001), and required revision stages (73.3% vs. 17.5%; P < 0.001). Crude local recurrence was higher in younger patients (22.2% vs. 5.8%; P = 0.001), as was documented dry eye syndrome (26.7% vs. 4.0%; P < 0.001). Age < 40 years was associated with increased recurrence risk on unadjusted analysis, but this association attenuated after adjustment for histology and clinical characteristics. CONCLUSION: Young adults with eyelid BCC showed distinctive exposure patterns, high-risk anatomic/surgical features, and higher crude recurrence. The age-recurrence association attenuated after adjustment, suggesting that age alone may not explain the observed difference.