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A reappraisal of cryosurgery for eyelid basal cell carcinomas
1University Eye Hospital Wuerzburg, Germany.
Background/Aims:
Liquid nitrogen spray freezing has been successfully applied for basal cell carcinomas in the eyelid region, but is not yet in general use. The reasons for this were analysed and the development of a more reliable, safer cryosurgical technique aimed for.
Methods:
New cryosurgical apparatus, contact probes with increased freezing power, and a special application technique were developed and clinically tested in a consecutive series of 221 patients with primary basal cell carcinomas of the lid region. Special efforts yielded follow up reports of 220 out of the 221 patients.
Results:
Experimental measurements and clinical results demonstrated that this cryosurgical technique was at least as effective as spray freezing, with lower risks. The rate of recurrent tumours in patients followed up for 5 years or longer was 5.1% (surgeons first result) respectively 0.6% (result after optimised second cryosurgery). The figures were 6.8%, respectively max 2.7%, when including all patients, independent of follow up time.
Conclusion:
Traditional surgery and histopathology, still used at numerous places, resulted in higher recurrence rates despite extended loss of healthy eyelid tissues and should be abandoned. Micrographic surgery is considered mandatory to save more of the healthy structures and to obtain lower recurrence rates. Cost and time require worldwide restriction of micrographic surgery to selected cases. Updated cryosurgery provides a low cost option to micrographic surgery and results in preservation of eyelid structures and lacrimal pathways, tarsal plate, lid margin. It provides excellent cosmetic results. Thus, primary basal cell carcinomas in the eyelid region of suitable size and location should receive updated cryosurgery, and tumours beyond its range micrographic surgery.
Insights
Updated cryosurgery offers a safer and effective alternative for eyelid basal cell carcinomas, achieving low recurrence rates and preserving eyelid structures. This method is a cost-effective option compared to micrographic surgery.
Area of Science:
- Ophthalmology
- Dermatology
- Oncology
Background:
- Liquid nitrogen spray freezing is effective for eyelid basal cell carcinomas but not widely adopted.
- Analysis of limitations led to the development of an improved cryosurgical technique.
Purpose of the Study:
- To develop and evaluate a more reliable and safer cryosurgical technique for eyelid basal cell carcinomas.
- To compare the efficacy and safety of the new technique with existing methods.
Main Methods:
- A new cryosurgical apparatus with enhanced freezing power and a specialized application technique were developed.
- The technique was clinically tested on 221 patients with primary basal cell carcinomas of the eyelid region.
- Follow-up data was obtained for 220 patients.
Main Results:
- The updated cryosurgery demonstrated effectiveness comparable to spray freezing but with reduced risks.
- Recurrence rates after 5 years were 5.1% (initial) and 0.6% (optimized).
- Overall recurrence rates, including all patients, were 6.8% and up to 2.7%.
Conclusions:
- Traditional surgery and histopathology for eyelid basal cell carcinomas have higher recurrence rates and cause tissue loss.
- Micrographic surgery is effective but costly; updated cryosurgery is a viable, cost-effective alternative for suitable tumors.
- Updated cryosurgery preserves eyelid structures, lacrimal pathways, and tarsal plate, yielding excellent cosmetic results.