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Staged excision of primary periocular basal cell carcinoma: absence of residual tumour in re-excised specimens: a 10-year series
  1. Lindsay A McGrath1,2,
  2. Adam Meeney3,
  3. Zanna I Currie2,
  4. Hardeep Singh Mudhar3,
  5. Jennifer H Tan2
  1. 1 School of Medicine, University of Queensland, Brisbane, Queensland, Australia
  2. 2 Sheffield Ocular Oncology Service, Royal Hallamshire Hospital, Sheffield, UK
  3. 3 National Specialist Ophthalmic Pathology Service (NSOPS), Department of Histopathology, E-Floor, Royal Hallamshire Hospital, Sheffield, UK
  1. Correspondence to Dr Lindsay A McGrath, Sheffield Ocular Oncology Service, Royal Hallamshire Hospital, Sheffield S10 2JF, UK; lindsay.mcg{at}gmail.com

Abstract

Aims The aim is to study staged periocular basal cell carcinoma (BCC) excision in a tertiary oculoplastic referral centre in Sheffield, UK. In particular, we examined patients with close or positive margins and no tumour seen on re-excision to identify demographics and tumour characteristics in this population.

Methods A retrospective review of medical records of 437 cases of staged periocular BCC excisions over a 10-year period (2007–2017) was carried out. Patients had surgical excision with 3 mm clinically clear margins. Staged excision was performed for all cases included in this study. Standard reconstruction techniques were employed. Histopathology was analysed for tumour type, subtype and stage.

Results Over the 10-year period, of the 437 periocular BCCs, 156 had close or involved margins. Residual tumour was found in 29 (18.6%), whereas in 122 eyelids of 120 patients (78.2%) no residual tumour was identified on histological examination. Micronodular (54.1%) and nodular (23.7%) growth patterns of BCC, as well as lower eyelid location (72.1%), were the most prevalent in this population. Two patients (1.6%) had recurrence of BCC over a mean follow-up of 57 months (range 1–125 months).

Conclusions A significant proportion of BCCs transected on initial excision show no residual tumour in the re-excision specimens. In the interval between initial excision and re-excision, there may be eradication of the residual tumour. The exact mechanisms for this are unclear, however, and re-excision remains the appropriate recommended course in the presence of involved surgical margins of periocular BCC, particularly when high-risk tumour subtypes are encountered.

  • neoplasia
  • pathology
  • treatment surgery
  • eyelids

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Footnotes

  • Contributors All authors contributed to the design and implementation of this research, to the analysis of the results and to writing of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval The duty and data accumulation were carried out with approval from Royal Hallamshire Hospital Ethics Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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