[N2 cryotherapy and excision. Indications and limits in eyelid basalioma]

Some ophthalmic surgeons have preferred N2-cryosurgery for many years. Others feel that only excisional surgery should be used. In this article both possibilities are discussed in an effort to facilitate a well-balanced choice. A total of 262 basalioma patients treated by cryosurgery from 1979 to 1988 were evaluated to assess the indications for cryosurgery. The histological findings were taken into consideration, as were the results of other authors. The comparison with histopathologically controlled excisions was based on discussions with users of the Mohs technique, literature, and personal experience. No other technique permits as much healthy tissue to be saved as N2-cryosurgery; this is especially important in the areas of the lid margin and lacrimal pathways. Complete involvement of the tumor edges can be achieved by generous extension of the treatment area and biopsies taken beyond the expected tumor margins and tumor base (subsequent to tunneling and cryosurgery from the basal side). In excisional surgery, the Mohs technique is required. Its advantage is that biopsies can be taken all around the tumor for histology and its disadvantage is prolonged operation time (in ad hoc frozen sections) or delayed wound closure (second or third surgical procedure several days later). This can be avoided in tumors that are suitable for cryosurgery. The Mohs technique, however, is mandatory in deeply infiltrating tumors in which cryosurgery is not indicated. The two methods complement one another. This is supported by the long-term results.