The Australian Mohs database, part I: periocular basal cell carcinoma experience over 7 years

Ophthalmology. 2004 Apr;111(4):624-30. doi: 10.1016/j.ophtha.2003.12.003.


Objective: To present the findings of all patients with periocular basal cell carcinoma (BCC) treated with Mohs' micrographic surgery (MMS) in Australia between 1993 and 1999.

Design: Prospective, noncomparative, multicenter, interventional case series.

Methods: Prospective series of 1295 patients undergoing MMS for periocular BCC over a 7-year period (1993-1999).

Inclusion criteria: Periocular BCC referred for MMS.

Main outcome measures: Site, tumor size, prior occurrence, defect size, histologic subtype, and presence of perineural invasion.

Results: Twelve hundred ninety-five patients had 615 (47.5%) lower eyelid, 626 (48.3%) medial canthus, and 51 (3.9%) upper eyelid BCCs. The most common histologic subtypes were nodulocystic (39.5%) and infiltrating (34.8%) (P = 0.0008). Sixty-eight percent were primary and 32% were recurrent tumors. Previously recurrent BCCs were larger (P<0.0001), with larger defects (P<0.0001) than primary BCCs, and had more subclinical extension (P<0.0001) requiring more levels for complete excision (P<0.0001). Furthermore, superficial BCCs were more likely to have a prior occurrence (P<0.0001). In this series, perineural invasion was found in 1% of cases, with greater subclinical tumor extension in such cases (P = 0.0657).

Conclusion: The Australian MMS database is the largest prospective, nationwide series of high-risk periocular BCC managed by MMS. Almost 50% of tumors were at the medial canthus, with nodulocystic and infiltrating being the most common histologic subtypes. Recurrent BCCs comprised a third of tumors and were larger, with larger defects and more subclinical extension than primary BCCs. Perineural invasion was found in 1% of cases and also had greater subclinical extension.

Publication types

  • Multicenter Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Australia
  • Carcinoma, Basal Cell / pathology
  • Carcinoma, Basal Cell / surgery*
  • Databases, Factual
  • Eyelid Neoplasms / pathology
  • Eyelid Neoplasms / surgery*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Mohs Surgery*
  • Neoplasm Invasiveness
  • Neoplasm Recurrence, Local / pathology
  • Prospective Studies