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Published on: December 29, 2016
Risk Factors for Canalicular Injury After Mohs Micrographic Surgery
Elliott H Campbell1, Daniel E Sotelo Leon2, Christian L Baum1
1Department of Dermatology, Mayo Clinic, Rochester, Minnesota.
Background:
There is a paucity of literature describing risk factors for canalicular injury (CI) during periocular Mohs micrographic surgery (Mohs).
Objective:
This study aimed to determine factors associated with CI after Mohs. This information may inform patient counseling and surgical planning.
Materials And Methods:
This case-control study compared subjects with canalicular injury after Mohs with subjects requiring ophthalmologic Mohs repair without canalicular injury. All subjects who had CI after Mohs were included in the control group. CI from other causes were excluded.
Results:
Basal cell carcinoma was the most common etiologic tumor (p < .00001). Canalicular injury was associated with infiltrative, morpheaform, and/or micronodular-type basal cell carcinoma. Initial tumor location involving the medial canthus was not statistically different between cases and controls (32% vs 17%, p = .22). Having a final defect involving the medial canthus region was more likely in cases versus controls (55% vs 26%, p = .01952).
Conclusion:
Although most final defects involved the medial canthal region, a substantial number of tumors resulting in CI did not initially seem to involve the medial canthus. Surgeons cannot rely simply on anatomical location when assessing risk for CI, and anticipation of need for canalicular reconstruction is challenging.
Insights
Identifying risk factors for canalicular injury (CI) during Mohs surgery is crucial. This study found CI is linked to specific basal cell carcinoma types and final defect location, not just initial tumor site.
Area of Science:
- Ophthalmology
- Dermatology
- Surgical Oncology
Background:
- Limited literature exists on risk factors for canalicular injury (CI) in periocular Mohs micrographic surgery (Mohs).
- Understanding these factors is essential for improving patient outcomes and surgical strategies.
Purpose of the Study:
- To identify factors associated with canalicular injury (CI) following Mohs surgery.
- To aid in patient counseling and surgical planning for Mohs procedures.
Main Methods:
- A case-control study design was employed.
- Cases with CI after Mohs were compared to controls without CI after Mohs.
- Exclusion criteria included CI from causes other than Mohs surgery.
Main Results:
- Basal cell carcinoma was the predominant tumor type (p < .00001).
- CI was associated with infiltrative, morpheaform, and micronodular basal cell carcinoma subtypes.
- While initial tumor location in the medial canthus was not significantly different, final defects involving the medial canthus were more common in cases with CI (55% vs 26%, p = .01952).
Conclusions:
- Surgeons should not solely rely on initial tumor location to predict CI risk.
- Anticipating the need for canalicular reconstruction can be challenging due to the nature of the final defect.
- Further research may refine predictive models for CI during Mohs surgery.
