Surgical treatment of periocular basal cell carcinomas with whole specimen intraoperative frozen section analysis: experiences and review of literature
- 49 Downloads
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.
KeywordsPeriocular 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.
- 4.Prabhakaran VC, Gupta A, Huilgol SC, Selva D (2007) Basal cell carcinoma of the eyelids. Compr Ophthalmol Updat 8:1–14Google Scholar
- 5.Aurora AL, Blodi FC (1970) Lesions of the eyelids. A clinicopathological study. Surv Ophthalmol 15:94–104Google Scholar
- 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
- 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
- 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
- 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