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Background: An ocular or periocular malignancy can profoundly impact patients' lives as they cope with the challenges of a potentially life-threatening diagnosis and the exhaustive treatment process it entails. An amalgam of biopsychosocial factors can influence prognosis. This study aims to determine whether marital status impacts the long-term survival of patients with these malignancies. Methods: A retrospective analysis of the Surveillance, Epidemiology, and End Results (SEER) database was performed. Patients with ocular and periocular malignancies diagnosed between 1973 and 2015 were included. The association between survival and marital status was assessed using univariate and multivariate Cox regression. Adjusted covariates included demographic, tumor, and treatment data. Results: A total of 3159 patients with a mean±SD follow-up period of 6.47±4.62 (range 0-17.9) years were studied. At the time of diagnosis, 63.4% (2004/3159) of the cohort were married, 12.9% (409/3159) were single, 16.3% (514/3159) were widowed, and 7.3% (232/3159) were divorced. The mean±SD age of the cohort was 64.4±15.17 (range 26-100) years, with histology distributed as 14.6% (462/3159) melanoma, 84.5% (2669/3159) lymphoma, and 0.9% (28/3159) plasmacytoma. Adjusted all-cause mortality risk was higher in single (HR, 1.885, 95% CI 1.535 to 2.314; P<0.001), widowed (HR, 1.382, 95% CI 1.169 to 1.635; P<0.001), and divorced (HR, 1.637, 95% CI 1.271 to 2.109; P<0.001) individuals compared to married individuals. Similarly, adjusted cause-specific mortality risk was higher in single (HR, 1.835, 95% CI 1.332 to 2.528; P<0.001), widowed (HR, 1.376, 95% CI 1.025 to 1.847; P=0.033), and divorced (HR, 1.873, 95% CI 1.272 to 2.758; P=0.001) individuals compared to married individuals. Conclusion: Unmarried (single, widowed, and divorced) individuals with ocular or periocular malignancies have unmet social support needs resulting in poorer long-term outcomes. Understanding the prognostic role of such psychosocial factors is necessary to improve the identification of and care for patients with inadequate support.

Background Although studies have investigated the risk of second primary malignancies (SPMs) associated with lymphoma of various sites, limited studies have investigated this risk in patients with lymphoma originating within the ocular adnexa. We conducted a retrospective study to assess incidence of secondary malignancies in patients with a prior diagnosis of ocular adnexal lymphoma (OAL) and to determine latency periods and age-groups at increased risk for SPM occurrence. Methods Retrospective analysis was performed on data obtained from Surveillance, Epidemiology, and End Results (SEER) 9 database. Patients with an initial primary malignancy diagnosis of OAL between 1973 and 2015 were included in the study. Standardized incidence ratios (SIR) and excess absolute risks (EAR) compared to a SEER reference population with similar sex, race, age, and calendar year were computed for SPMs. Excess absolute risk is per 10,000 individuals; alpha of 0.05 was used. Results Of 1834 patients with primary ocular adnexal lymphoma, 279 developed a secondary malignancy during average follow-up of 110.03 months (+/− 88.46), denoting higher incidence than expected (SIR 1.20; 95% CI, 1.07 to 1.35; EAR 30.56). Amongst the primary lymphoma cohort, 98.7% (1810/1834) of patients had non-Hodgkin’s lymphoma and amongst those that developed secondary malignancies, 99.6% (278/279) had non-Hodgkin’s lymphoma. Patients exhibited increased incidence of lymphohematopoietic and non-lymphohematopoietic second malignancies and no secondary malignancies of the eye or orbit. Patients had increased incidence of secondary malignancies in the first year (SIR 2.07; 95% CI, 1.49 to 2.79; EAR 150.37) and 1–5 years following lymphoma diagnosis (SIR 1.24; 95% CI, 1.01 to 1.51; EAR 34.89). Patients with various OAL subtypes demonstrated differing patterns of site-specific and overall SPM risk. Conclusions Patients with prior diagnosis of ocular adnexal lymphoma possess increased risk of hematologic and non-hematologic secondary malignancies. Risk of secondary malignancy could vary by lymphoma subtype. Patients with ocular adnexal lymphoma may benefit from regular surveillance to promote early detection of second primary malignancies.

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