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[Surgical management of periocular basal cell carcinoma using frozen section control and immediate plastic
L M Holbach1, A Jünemann, S Muhammad
1Augenklinik mit Poliklinik, Universität Erlangen-Nürnberg.
Purpose:
To review our first experiences with the surgical removal of basal cell carcinoma (BCC) utilizing frozen section control and immediate plastic reconstruction.
Patients And Methods:
We analyzed the accuracy of clinical diagnosis, methods of surgical excision, plastic repair and recurrence rates in 162 consecutive patients who underwent surgical excision utilizing either frozen section (n = 106) or biomicroscopic control (n = 56) between January 1991 and June 1996. Specimens used for intraoperative frozen-section monitoring were also fixed, processed, and sectioned for permanent sections and served as postoperative controls for the frozen sections (n = 43).
Results:
The accuracy of clinical diagnosis was 86% (n = 189). In 106 patients with BCC excised with frozen section control, there were no recurrences reported after a mean follow-up of 2.9 years. The mean surgical defect measured 55% of total eyelid length (range 10%-100%). The incidence of morphea pattern was 34%. Intraoperative re-excisions due to frozen sections positive for tumor were necessary in 31% of cases. Permanent postoperative sections of the tissue that had been used for intraoperative frozen sections confirmed in 97.5% of patients (n = 43) the preliminary findings made with frozen sections. In 56 patients with BCC excised with biomicroscopic control, three tumors recurred (5%) after a mean follow-up of 4.4 years. The mean surgical defect measured 42% of total eyelid length (range 16%-100%). The incidence of morphea type was 23%.
Conclusion:
Surgical removal utilizing frozen section control and immediate plastic repair appears to represent a reliable and effective option in the management of selected patients with periocular BCC.