A review of 24 cases of Mohs surgery and ophthalmic plastic reconstruction

Mohs surgery (micrographically controlled excision) has been advocated as an effective method of dealing with infiltrative periorbital skin tumours. It has been shown to have high rates of tumour clearance with minimal loss of normal tissue, thus making oculoplastic reconstruction easier and functional preservation better. The aim of the present study was to confirm this. Guidelines for the selection of patients for Mohs surgery are discussed.

We retrospectively reviewed 24 cases of primary (n = 18) and recurrent (n = 6) periorbital basal and squamous cell carcinomas managed by Mohs micrographic excision and plastic reconstruction who presented to the Royal Perth Hospital between 1992 and 1996.

Our high rate of tumour clearance (100%) was similar to that of previous studies, although our follow-up period was only 14.6 months. The fact that 50% of our patients with lid involvement had an intact posterior lamella after Mohs excision correlates with the high level of normal tissue preservation. The low rate of postoperative symptomatic problems suggests good maintenance of function. The infiltrative nature of these tumours was highlighted by the substantial proportion of cases (37.5%) that had a much larger excision defect than what was expected prior to excision.

Our analysis confirms that Mohs excision and subsequent oculoplastic reconstruction is an effective method to use when managing periorbital infiltrative skin tumours.