Purpose: Our objective was to assess the results of surgical management of palpebral basal cell carcinomas (BCC) followed by a second line treatment discussed during a Multidisciplinary Team Meeting (MTM).
Materials and methods: This retrospective single-centred study includes all surgically-treated basal cell carcinomas of the eyelids between January 2005 and January 2015. After initial surgery, the cases were systematically discussed during a multidisciplinary team meeting in order to assess the need for additional treatment. Data relative to the patient, tumor and management were pulled from the medical record.
Results: A total of 171 patients were included, with a mean age of 74 years. Among the patients, 151 underwent pentagonal resection of the tumor, and 20 patients had a superficial excision. After surgical management, 120 patients (70.2%) were considered to have sufficient free margins. The other 51 patients (29.8%) had insufficient margins due to remaining tumor cells (38 patients) or free margins less than 1mm. Among these 51 patients with insufficient margins, 19 received a second surgical treatment, 17 patients received adjuvant radiotherapy, and 15 were followed closely with an intensive biannual follow-up program. No patients were lost to follow-up. With a mean follow-up of 42 months (min. 6 months-max. 128 months), 7 out of 171 patients (4.1%) developed a local recurrence. The mean time between surgical management and recurrence was 24 months. The recurrence rate was higher for the group of patients with a recurrent tumor (11.6%) than for the group of patients referred for initial management (2.8%). Incomplete resection was also associated with a higher recurrence rate (3 recurrences out of 51 patients).
Discussion: The management of basal cell carcinomas of the eyelid is first and foremost surgical with the goal of complete resection confirmed by histopathological analysis. The histological analyses (Mohs micrographic surgery, frozen section technic, paraffin fixation) and recommended sizes of the margins can vary in the literature, with recurrence rates from 1.8% to 9.5%.
Conclusion: In our experience, multidisciplinary management of BCC of the eyelid, including initial macroscopic surgery, histopathological analysis stating the histological type and size of the margins, along with additional treatment discussed in a MTM, allows for a recurrence rate of 4.1%.
Keywords: Basal cell carcinoma; Carcinome basocellulaire; Eyelid; Fixation paraffine; Histologie; Histology; Multidisciplinary team conference; Oncologie; Oncology; Paraffin fixation; Paupière; Réunion de concertation pluridisciplinaire; Surgical treatment; Traitement chirurgical.
Copyright © 2019 Elsevier Masson SAS. All rights reserved.
[Clinical and Histologic Features of 141 Primary Basal Cell Carcinomas of the Periocular Region and Their Rate of Recurrence After Surgical Excision]CW Spraul et al. Klin Monbl Augenheilkd 217 (4), 207-14. PMID 11098454.Surgical excision of basal cell carcinomas of the periocular region without utilizing intraoperative frozen section control or Mohs' micrographic surgery is associated wi …
[Clinical Study and Risk Factors for Recurrence of Basal Cell Carcinoma of the Eyelid: Results of a Tunisian Series and Review of the Literature]L Knani et al. J Fr Ophtalmol 37 (2), 107-14. PMID 24486074. - ReviewBasal cell carcinoma represents the most frequent malignant tumor of the eyelids. Surgery remains the standard treatment. The "wait and see" approach offers an interestin …
Clinical, Histopathological and Therapeutical Analysis of Inferior Eyelid Basal Cell CarcinomasM Totir et al. J Med Life 7 Spec No. 4 (Spec Iss 4), 18-22. PMID 27057245. - ReviewThe review resulted in 36 patients with 36 lesions analyzed by clinical, histopatological and therapeuticalaspectswith a mean follow-up of 20 months. All lesions were pri …
Outcome of 110 Basal Cell Carcinomas of the Eyelid Treated With Frozen Section-Controlled Excision: Mean Follow-Up Over 5 YearsA Giordano Resti et al. Eur J Ophthalmol 24 (4), 476-82. PMID 24338583.The FSC excision of eyelid BCCs yields recurrence rates comparable to those of Mohs micrographic surgery at 5-year follow-up. Intraoperative microscopic margin control im …
Eyelid Margin Basal Cell Carcinoma Managed With Full-Thickness En-Face Frozen Section HistopathologyHS Gill et al. Ophthalmic Plast Reconstr Surg 30 (1), 15-9. PMID 24398481.Eyelid margin BCC can be managed effectively with full-thickness en-face frozen section-controlled excision and primary reconstruction of the defect. The high cure rate c …