Mohs surgery vs primary excision for eyelid BCCs

James Tildsley, Charles Diaper, Robert Herd
Orbit 2010, 29 (3): 140-5

INTRODUCTION: The aims of management of basal cell carcinoma are for complete excision, and minimise damage to the surrounding tissues. Our aim is to compare the proposed defect of a primary excision biopsy with the actual defect following Mohs micrographic surgery on the same lesions.

MATERIALS AND METHODS: A cohort of 23 patients about to undergo Mohs micrographic surgery for eyelid basal cell carcinomas was recruited. The lesions were assessed regarding size and location. A digital photograph of the lesions pre Mohs excision and the defects post Mohs excision for analysis on the Photoshop Adobe package using the caliper function to measure the eyelid lesion, and defects and to calculate the area.

RESULTS: All 18 patients had solitary basal cell carcinomas; 9 (50%); 10 of the 18 cases having a larger proposed primary excision defect and the remaining 8 cases a larger post-Mohs micrographic surgery defect area.

DISCUSSION: Basal cell carcinoma is the most common non-melanoma malignant eyelid tumour. The results supported basal cell carcinomas, particularly morphoeic types, are difficult to examine, and location is a poor predictor of recurrence. We did not find that Mohs micrographic surgery universally reduces the size of the defects area. However, if the primary aim of the surgery is to cure the patient and prevent recurrence, Mohs is still the best choice.

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