European Journal of Plastic Surgery

, Volume 41, Issue 6, pp 637–642 | Cite as

Surgical treatment of periocular basal cell carcinomas with whole specimen intraoperative frozen section analysis: experiences and review of literature

  • Paul G. BosEmail author
  • Kor H. Hutting
  • Pauline M. Huizinga
  • Klaas W. Marck
  • Robby E. Kibbelaar
  • Chantal M. Mouës
Original Paper



Periocular skin tumors are difficult to treat because of the friability of the tissue and close relationship to adjacent, functional structures. After excision, direct reconstruction with alike tissue is desirable to prevent shrinkage and deformation. We analyzed whether a quick intraoperative pathology method using whole specimen bread loaf frozen section analysis delivers a sufficiently reliable result concerning completeness of the excision in periocular basal cell carcinoma (BCC).


This is a cohort study by case note review of 132 patients undergoing excision of periocular BCC between 1996 and 2012 at the Medical Centre Leeuwarden. Whole specimen intraoperative frozen section analysis (WIFSA) was performed and compared with final paraffin-embedded tissue sections. Sensitivity and specificity of WIFSA and 5-year recurrence rate were calculated.


One hundred thirty-nine periocular BCCs were excised. Paraffin sections of primary excision showed clear margins in 90 cases and tumor-positive margins in 49 cases. In 87 of 90 excisions with clear margins, WIFSA showed clear margins as well (specificity 97%). In 48 of the 49 excisions with tumor-positive margins, WIFSA showed incomplete excision as well (sensitivity 98%). Recurrence rate was 3.6% (5/139), with average follow-up of 79 months.


This study indicates that WIFSA is an effective method for histological examination of the margins of surgically removed periocular BCCs, with high specificity and sensitivity. Recurrence rates are low.

Level of Evidence: Level II, diagnostic study.


Periocular basal cell carcinoma Whole specimen intraoperative frozen section analysis Recurrence 


Compliance with ethical standards


None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this manuscript. No funding was received.

Conflict of interest

Paul G. Bos, Kor H. Hutting, Pauline M. Huizinga, Klaas W. Marck, Robby E. Kibbelaar, and Chantal M. Mouës declare that they have no conflict of interest.

Ethical approval

Not applicable.

Informed consent

Not applicable.


  1. 1.
    Kleinstein RN, Lehman HF (1977) Incidence and prevalence of eye cancer. Am J Optom Physiol Optic 54:49–51CrossRefGoogle Scholar
  2. 2.
    Loeffler M, Hornblass A (1990) Characteristics and behavior of eyelid carcinoma (basal cell, squamous cell sebaceous gland, and malignant melanoma). Ophthalmic Surg 21:513–518PubMedGoogle Scholar
  3. 3.
    Margo CE, Waltz K (1993) Basal cell carcinoma of the eyelid and periocular skin. Surv Ophthalmol 38:169–192CrossRefGoogle Scholar
  4. 4.
    Prabhakaran VC, Gupta A, Huilgol SC, Selva D (2007) Basal cell carcinoma of the eyelids. Compr Ophthalmol Updat 8:1–14Google Scholar
  5. 5.
    Aurora AL, Blodi FC (1970) Lesions of the eyelids. A clinicopathological study. Surv Ophthalmol 15:94–104Google Scholar
  6. 6.
    Cook BE Jr, Bartley GB (2001) Treatment options and future prospects for the management of eyelid malignancies: an evidence-based update. Ophthalmology 108:2088–2098CrossRefGoogle Scholar
  7. 7.
    Wojcicki P, Zachara M (2010) Surgical treatment of eyelid tumors. J Craniofac Surg 21:520–525CrossRefGoogle Scholar
  8. 8.
    Hamada S, Kersey T, Thaller VT (2005) Eyelid basal cell carcinoma: non-Mohs excision, repair, and outcome. Br J Ophthalmol 89:992–994CrossRefGoogle Scholar
  9. 9.
    Lingren G, Larko O (1997) Long term follow-up of cryosurgery of basal cell carcinoma of the eyelid. J Am Acad Dermatol 36:742–746CrossRefGoogle Scholar
  10. 10.
    Avril MF, Auperin A, Margulis A, Gerbaulet A, Duvillard P, Benhamou E, Guillaume JC, Chalon R, Petit JY, Sancho-Garnier H, Prade M, Bouzy J, Chassagne D (1997) Basal cell carcinoma of the face: surgery or radiotherapy? Results of a randomized study. Br J Cancer 76:100–106CrossRefGoogle Scholar
  11. 11.
    Geisse J, Caro I, Lindholm J, Golitz L, Stampone P, Owens M (2004) Imiquimod 5% cream for the treatment of superficial basal cell carcinoma: results from two phase III, randomized, vehicle-controlled studies. J Am Acad Dermatol 50:722–733CrossRefGoogle Scholar
  12. 12.
    Wang I, Bendsoe N, Klinterberg C et al (2001) Photodynamic therapy versus cryosurgery of basal cell carcinomas: results of a phase III clinical trial. Br J Dermatol 144:832–840CrossRefGoogle Scholar
  13. 13.
    Mohs FE (1986) Micrographic surgery for the microscopically controlled excision of eyelid cancer: history and development. Adv Ophthalmic Plast Reconstr Surg 5:381–408PubMedGoogle Scholar
  14. 14.
    Gal AA, Cagle PT (2005) The 100-year anniversary of the description of the frozen section procedure. JAMA 294:3135–3137CrossRefGoogle Scholar
  15. 15.
    Narayanan K, Hadid OH, Barnes EA (2012) Mohs micrographic surgery versus surgical excision for periocular basal cell carcinoma. Cochrane Database Syst Rev 2:CD007041Google Scholar
  16. 16.
    Gooding CA, White G, Yatsuhashi M (1965) Significance of marginal extension in excised basal-cell carcinoma. N Engl J Med 273:923–924CrossRefGoogle Scholar
  17. 17.
    Sarma DP, Griffing CC, Weilbaecher TG (1984) Observations on the inadequately excised basal cell carcinomas. J Surg Oncol 25:79–80CrossRefGoogle Scholar
  18. 18.
    Older JJ, Quickert MH, Beard C (1965) Surgical removal of basal cell carcinoma of the eyelids utilizing frozen section control. Am J Ophthalmol 79:658–663Google Scholar
  19. 19.
    Chalfin J, Putterman AM (1979) Frozen section control in the surgery of basal cell carcinoma of the eyelid. Am J Ophthalmol 87:802–809CrossRefGoogle Scholar
  20. 20.
    Doxanas MT, Green WR, Iliff CE (1981) Factors in the successful management of basal cell carcinoma of the eyelids. Ophthalmology 91:726–736Google Scholar
  21. 21.
    Frank HJ (1989) Frozen section control of excision of eyelid basal cell carcinomas: 8-1/2 years’ experience. Br J Ophthalmol 73:328–332CrossRefGoogle Scholar
  22. 22.
    Tijl JW, Koornneef L (1991) The surgical treatment of basal cell carcinoma of the eyelids. Ned Tijdschr Geneeskd 135:471–474PubMedGoogle Scholar
  23. 23.
    Glatt HJ, Olson JJ, Putterman AM (1992) Conventional frozen sections in periocular basal-cell carcinoma: a review of 236 cases. Ophthalmic Surg 23:6–9PubMedGoogle Scholar
  24. 24.
    Wong VA, Marshall JA, Whitehead KJ, Williamson RM, Sullivan TJ (2002) Management of periocular basal cell carcinoma with modified en face frozen section controlled excision. Ophthal Plast Reconstr Surg 18:430–435CrossRefGoogle Scholar
  25. 25.
    Conway RM, Themel S, Holbach LM (2004) Surgery for primary basal cell carcinoma including the eyelid margins with intraoperative frozen section control comparative interventional study with a minimum clinical follow up of 5 years. Br J Ophthalmol 88:236–238CrossRefGoogle Scholar
  26. 26.
    Nemet AY, Deckel Y, Martin PA, Kourt G, Chilov M, Sharma V, Benger R (2006) Management of periocular basal and squamous cell carcinoma: a series of 45 cases. Am J Ophthalmol 142:293–297CrossRefGoogle Scholar
  27. 27.
    Taherian K, Shekarchian M, Atkinson PL (2007) Surgical excision of periocular basal cell carcinomas. Indian J Ophthalmol 55:137–138CrossRefGoogle Scholar
  28. 28.
    Gayre GS, Hybarger CP, Mannor G, Meecham W, Delfanti JB, Mizono GS, Guerry TL, Chien JS, Sooy CD, Anooshian R, Simonds R, Pietila KA, Smith DW, Dayhoff DA, Engman E, Lacy J (2009) Outcomes of excision of 1750 eyelid and periocular skin basal cell and squamous cell carcinomas by modified en face frozen section margin-controlled technique. Int Ophthalmol Clin 49:97–110CrossRefGoogle Scholar
  29. 29.
    Levin F, Khalil M, McCormick SA, Della Rocca D, Maher E, Della Rocca RC (2009) Excision of periocular basal cell carcinoma with stereoscopic microdissection of surgical margins for frozen-section control: report of 200 cases. Arch Ophthalmol 127:1011–1015CrossRefGoogle Scholar
  30. 30.
    Tullet M, Sagili S, Barrett A, Malhotra R (2013) Excision of periocular basal cell carcinoma guided by en face frozen section. Br J Oral Maxillofac Surg 51:520–524CrossRefGoogle Scholar
  31. 31.
    Malhotra R, Huilgol SC, Huynh NT, Selva D (2004) The Australian Mohs database. Part II: periocular basal cell carcinoma outcome at five-year follow-up. Ophthalmology 111:631–636CrossRefGoogle Scholar
  32. 32.
    Robins P, Rodriquez-Sains R, Rabinovitz H et al (1985) Mohs surgery for periocular basal cell carcinomas. J Dermatol Surg Oncol 11:1203–1207CrossRefGoogle Scholar
  33. 33.
    Pieh S, Kuchar A, Novak P, Kunstfeld R, Nagel G, Steinkogler FJ (1999) Long term results after surgical basal cell carcinoma excision in the eyelid region. Br J Ophthalmol 83:85–88CrossRefGoogle Scholar
  34. 34.
    Moncrieff MD, Shah AK, Igali L et al (2015) False-negative rate of intraoperative frozen section margin analysis for complex head and neck nonmelanoma skin cancer excisions. Clin Exp Dermatol 40:834–838CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Paul G. Bos
    • 1
    Email author
  • Kor H. Hutting
    • 1
  • Pauline M. Huizinga
    • 1
  • Klaas W. Marck
    • 1
  • Robby E. Kibbelaar
    • 2
  • Chantal M. Mouës
    • 1
  1. 1.Department of Plastic Surgery and Hand SurgeryMedical Centre LeeuwardenLeeuwardenThe Netherlands
  2. 2.Pathology FrieslandLeeuwardenThe Netherlands

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