Predictors for margin of resection >4 mm in the management of periocular basal cell carcinoma
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Purpose: To determine the margin of resection (MOR) for periocular basal cell carcinoma (BCC) and compare the outcomesof BCC treatment, namely Mohs micrographic surgery (MMS) and wide excision with later reconstruction (WELR). Methods: This is a retrospective, comparative, interventional study of patients who underwent surgical treatment of periocularBCC. One hundred forty-two patients were included. One hundred patients were treated with MMS and 42 with WELR. Inclusion criteria were primary periocular BCC with postoperative follow-up of ≥6 months, age more than 18-year-old. Exclusioncriteria were, orbital extension, BCC origin outside the periocular area, or those associated with Gorling or nevoid BCC. The main outcome measure was variables associates with MOR >4 mm. Results: There was a positive correlation between the preoperative tumor horizontal and vertical diameter with the correspondingMOR, of 0.27 (p = 0.01) and 0.28 (p = 0.007), respectively. Receiver operating characteristics suggest that a tumorwith a horizontal diameter ≥5 mm or a vertical diameter of ≥6 mm, might need MOR >4 mm. One patient in the MMS grouphad BCC recurrence compared to none in the WELR group, and one patient in the WELR had a positive surgical margin, whichwas cleared during the reconstruction. Conclusions: BCC tumor margins may extend far beyond clinical margins and the MOR required is often more than 3–4 mm. MMS ensures clear tumor margins but is not practical for all patients. A stratification system could help divide patients betweenthe treatment strategies.
Abstract
Purpose: To determine the margin of resection (MOR) for periocular basal cell carcinoma (BCC) and compare the outcomesof BCC treatment, namely Mohs micrographic surgery (MMS) and wide excision with later reconstruction (WELR). Methods: This is a retrospective, comparative, interventional study of patients who underwent surgical treatment of periocularBCC. One hundred forty-two patients were included. One hundred patients were treated with MMS and 42 with WELR. Inclusion criteria were primary periocular BCC with postoperative follow-up of ≥6 months, age more than 18-year-old. Exclusioncriteria were, orbital extension, BCC origin outside the periocular area, or those associated with Gorling or nevoid BCC. The main outcome measure was variables associates with MOR >4 mm. Results: There was a positive correlation between the preoperative tumor horizontal and vertical diameter with the correspondingMOR, of 0.27 (p = 0.01) and 0.28 (p = 0.007), respectively. Receiver operating characteristics suggest that a tumorwith a horizontal diameter ≥5 mm or a vertical diameter of ≥6 mm, might need MOR >4 mm. One patient in the MMS grouphad BCC recurrence compared to none in the WELR group, and one patient in the WELR had a positive surgical margin, whichwas cleared during the reconstruction. Conclusions: BCC tumor margins may extend far beyond clinical margins and the MOR required is often more than 3–4 mm. MMS ensures clear tumor margins but is not practical for all patients. A stratification system could help divide patients betweenthe treatment strategies.
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