Management of periocular basal cell carcinoma: Mohs' micrographic surgery versus radiotherapy

In treating periocular basal cell carcinoma the goal is to achieve the most complete eradication of affected tissue while preserving as much healthy tissue as possible. In the first of these "Viewpoints" articles, Drs. Leshin and Yeatts discuss the success of Mohs' microsurgical technique (MMS) in both regards. Moreover, they note that MMS offers the additional advantage of placing all surgical and histological phases of tumor excision in the hands of one specialist, thus circumventing problems that may arise with procedures requiring the separate involvement of several specialists. In the second article, Drs. Anscher and Montana point out that modern radiotherapy techniques may offer adequate tumor control with less damage to surrounding tissues than is caused by surgical excision and reconstruction. With small lesions, radiotherapy has a success rate similar to that of surgery. With large lesions, the success rate is lower; however, if surgical excision would cause extensive disfigurement or functional damage, an initial trial of radiotherapy may be warranted, then followed by surgery, if necessary. In an editorial, Dr. Dutton summarizes the indications for and advantages and disadvantages of both techniques.