Small margin (up to 2 mm) excision of periocular basal cell carcinomas in the setting of a one-stop clinic — long-term outcomes at a minimum of 11 years’ follow-up

Abstract

Objectives: To analyse the long-term outcome of small margin (up to 2 mm) excision of clinically well-demarcated primary periocular basal cell carcinomas (BCCs). Methods: Retrospective evaluation of 185 patients with excised well-demarcated primary BCCs at a minimum of 11 years following excision. All patients underwent tumour excision with maximum margins of 2 mm. Resulting defects were, if possible, closed directly. Reconstruction requiring flaps or grafts was delayed until receipt of the histological report, which was obtained in all cases. Results: Of 185 patients evaluated, 69 (37.3%) were still alive at the time of the study, at least 11 years post excision. One-stage excision and direct closure was performed in 60/69 patients (86.96%). In 9/69 patients (13.04%), excision was undertaken with reconstruction 4 days later, after receipt of the histopathology report. Histological assessment confirmed complete initial excision in 59/69 patients (85.5%) rising to 68 (98.6%) after two excisions. Mean follow-up was 13 years, with no recurrence in the living cohort. Three deceased patients had a recurrence, one of whose tumour was reported histologically as incompletely excised but declined further surgery, giving an overall recurrence rate of 3/185 (1.62%). For patients who completed treatment, the recurrence rate was 2 in 184 (1.09%). Six of the sixty-nine patients (8.7%) developed new tumours on the contralateral eyelid or the forehead. Conclusions: Primary, clinically well-demarcated periocular BCCs can be safely treated using small (up to 2 mm) excision margins in a one-stop setting with immediate reconstruction for those defects which can be closed directly without recourse to flaps or grafts. Synopsis: A retrospective study of 185 patients who had small margin (≤2 mm) excision of clinically well-demarcated primary periocular BCCs demonstrated a recurrence rate of 3/185 (1.62%) at a minimum of 11 years’ follow-up.