Lin et al of every patient admitted for Mohs surgery. The records were reviewed for patient history, presentation, lesion size, number of Mohs stages for excision, and defect size. The clinical records of these same patients from the Department of Oculoplastics and Reconstructive Surgery at Doheny Eye Institute were also reviewed. The records were reviewed for patient history, presentation, lesion duration and appearance, type of closure needed for reconstruction, and recurrence. No patient had previous treatment or biopsies prior to Mohs excision. The histopathological slides were read at the time of Mohs excision by the dermatopathologist. The study pro- tocol was approved by the University of Southern California Institutional Review Board. Results Sixty-nine of 79 eyelid skin cancer cases were found to have basal cell carcinoma. Of these 69 patients, 8 were of Hispanic descent. Four of these patients had PBCC. Representative clinical photographs are seen in Figure 1 (Case 1) and Figure 2 (Case 4). All four patients were male, with a mean age of 63 years (range 57 to 75 years). Lesion duration ranged from 7 months to 6 years. None of these patients had lymph- adenopathy. Two patients felt the lesion was secondary to minor trauma. All patients were treated with Mohs excision. No patient has experienced recurrence. There were no cases of neural or perineural involvement. Table 1 summarizes the ﬁndings for all four patients. Discussion A 2001 report (Harris et al 2001) on trends in the incidence of nonmelanoma skin cancers in southeastern Arizona found Figure 1 Darkly pigmented well -circumscribed, spherical, peduculated nodule of left upper lid. 642 Figure 2 Pigmented, raised lesion encompassing right lower lid with areas of ulceration and madarosis, inﬁltrating the lid margin. that non-Hispanic whites were 11 times more likely than Hispanics to develop either basal or squamous cell carci- noma. Similarly, a 1982 report on the incidence of basal cell carcinoma and melanoma in New Mexico found that these cancers occurred seven times less often in Hispanics than in non-Hispanics (Pathak et al 1982). Although both basal and squamous cell carcinoma, as well as melanoma, occur with less frequency in the Hispanic population than in the non-Hispanic population, it has been shown that PBCC occurs more often in Hispanics. In one prospective series (Bigler et al 1996), for BCC at any site, 66% of all BCCs in Hispanics were found to be PBCC, whereas only 11% of all BCCs in non-Hispanic patients were PBCC. Pigmented basal cell carcinoma has also been shown to occur with higher frequency in patients with darker skin color (Smith et al 1960; Kalter et al 1984; Abreo and Sanusi 1991). Histologic studies have shown that the pigment in PBCC originates from the surrounding skin (Bleehan 1975). Hornblass and Stefano (1981) described pigmented basal cell carcinoma speciﬁc to the eyelid in white patients. Haye and Duﬁer (1976) reported a relative frequency of 1% for PBCC of the eyelid in the population in Paris, which increased to 45% in Mediterranean ethnic groups. After careful review of the literature, to the best of the authors’ knowledge, eyelid PBCC speciﬁc to the Hispanic population has not been reported. Just as eyelid PBCC is more frequent in the darker skinned Mediterranean population, it is likely that PBCC of the eyelid also occurs more commonly in Hispanics than in non-Hispanics. Because PBCC is not commonly considered in the dif- ferential of eyelid pigmented lesions of general ophthalmolo- gists, these lesions are often misdiagnosed as melanoma. Both lesions can have irregular borders and dark pigment. How- ever, some features of PBCC can help differentiate it from Clinical Ophthalmology 2008:2(3)