[Recurrence risk of periocular basal cell carcinoma after histologically controlled excision]

The incidence of basal cell carcinoma (BCC) has significantly increased in the last decades. The aim of this retrospective study was to determine the risk of recurrence of periocular BCC after histologically controlled resection.

Based on the clinical records from 2009-2020 a total of 270 consecutive periocular BCCs from 243 patients were investigated with respect to recurrence after surgical excision. For this study, the type of BCC (primary or recurrent BCC) and localization within the orbital region (upper eyelid nasal, middle, temporal and lower eyelid nasal, middle, temporal) and the histological BCC subtype, e.g. solid/nodular (s/n), superficial multicentric (s-m), infiltrative/sclerodermal (i/s), basosquamous (bsq) and mixed (gem), were recorded. Recurrence rates were compared using χ²-tests.

The 270 resected BCCs with 231 primary BCC (pBCC) and 39 already recurrent BCC (rBCC), were included in this study. Among the 231 pBCCs we recorded a total of 38 (16.5%, 2‑year recurrence rate 9.2%) recurrences for the abovementioned period. In the 39 rBCCs we observed 18 (46.2%) recurrences (2-year recurrence rate 37.8%). In addition, a significantly shorter recurrence-free interval (RFV, ∅ 52.6 ± 9.0 months) was observed for the rBCC than for the pBCC (∅108.6 ± 4.1 months, p < 0.001). The recurrence rates did not differ significantly with respect to the location; however, there was a significant difference between the five defined subtypes (p = 0.001): s/n = 15.9%, s‑m = 45.0%, i/s = 27.8%, bsq = 33.3% and gem = 40.0%. After R0 resection the recurrence rate of s/n BCC was significantly lower than after R?/R1 resection (p = 0.008). The histological subtypes i/s (p = 0.433), bsq (p = 0.417), and gem (p = 0.143), showed no significant difference between the recurrence rates after R0 and R?/R1 resection. In s‑m BCC, a conclusion on the statistical significance was not possible.

The recurrence rate appears to be comparatively high; however, R1 resected BCCs were intentionally included in this study to obtain an evaluation that reflects clinical practice as realistically as possible. It is possible that the surgical procedure and/or the type of histological examination as well as the broad interpretation of the term local recurrence could be the reason for the different recurrence data in the literature. Our data indicate that the recurrence rate is not affected by the exact localization within the orbital region, but by the respective BCC subtype. As recurrences may develop years after BCC excision a long-term follow-up is strictly recommended.