Recurrence rates following surgical excision of periocular basal cell carcinomas: systematic review and meta-analysis

Background: Basal cell carcinomas (BCCs) remain one of the most common non-melanoma skin cancers (NMSCs). Surgical options include primary excision with predetermined margins, frozen section controlled excision, and Mohs micrographic surgery (MMS). There is no randomized study comparing recurrence rates between different surgical techniques for periocular BCCs.Methods: A meta-analysis of proportions was conducted for recurrence rates. Meta-regression was used for subgroup analysis to compare results in those undergoing MMS versus FSE or paraffin controlled sections (WLE).Results: The pooled recurrence rate for periocular BCCs excised via MMS was 2.9% (95% CI 1.9-4.4%) over an average of 48.8 ± 14.9 months. The pooled recurrence rate for FSE was 1.9% (95% CI 1.9-2.4%) over an average of 70.7 ± 48.0 months. By comparison, the pooled recurrence rate following WLE was 5.9% (95% CI 3.9-8.9%) over an average of 49.2 ± 29.3 months. Meta-regression demonstrated that the recurrence rate for WLE was significantly higher compared to MMS and FSE techniques (p<.001) but similar for MMS and FSE (p=.65).Conclusions: Our results highlight the importance of intraoperative margin assessment in the management of BCCs in order to reduce recurrence. These factors should be taken into consideration in the workup and management of patients with periocular BCCs.