A reappraisal of cryosurgery for eyelid basal cell carcinomas

Abstract

Background/aims: Liquid nitrogen spray freezing has been successfully applied for basal cell carcinomas in the eyelid region, but is not yet in general use. The reasons for this were analysed and the development of a more reliable, safer cryosurgical technique aimed for. Methods: New cryosurgical apparatus, contact probes with increased freezing power, and a special application technique were developed and clinically tested in a consecutive series of 221 patients with primary basal cell carcinomas of the lid region. Special efforts yielded follow up reports of 220 out of the 221 patients. Results: Experimental measurements and clinical results demonstrated that this cryosurgical technique was at least as effective as spray freezing, with lower risks. The rate of recurrent tumours in patients followed up for 5 years or longer was 5.1% (surgeons first result) respectively 0.6% (result after optimised second cryosurgery). The figures were 6.8%, respectively max 2.7%, when including all patients, independent of follow up time. Conclusion: Traditional surgery and histopathology, still used at numerous places, resulted in higher recurrence rates despite extended loss of healthy eyelid tissues and should be abandoned. Micrographic surgery is considered mandatory to save more of the healthy structures and to obtain lower recurrence rates. Cost and time require worldwide restriction of micrographic surgery to selected cases. Updated cryosurgery provides a low cost option to micrographic surgery and results in preservation of eyelid structures and lacrimal pathways, tarsal plate, lid margin. It provides excellent cosmetic results. Thus, primary basal cell carcinomas in the eyelid region of suitable size and location should receive updated cryosurgery, and tumours beyond its range micrographic surgery.

Management of malignant and benign eyelid lesions

“…Following the excision of the tumor the eyelid should be reconstructed by standard oculoplastic procedures and should be performed expeditiously. Despite the fact that cryosurgery has been considered suboptimal for the treatment of periocular BCCs in the past, a high success rate, with the recurrence rate near 0% and minimal side effects, has been reported by several authors using a double freeze-and-thaw technique with a standard cryprobe directly applied to the BCC [17,18]. Cryotherapy might be a reasonable choice for the treatment of periocular nodular or noduloulcerative BCC in patients who are poor candidates for surgery.…”

“…This greatly depends on the ability and the experience of the dermatopathologist that performs the Mohs procedure, however, and many surgeons prefer to excise the BCC with clinically free margins (2 mm) and to control the margins histologically with frozen or permanent sections [16]. The recurrence rate for primary BCCs excised with margin control is very low, ranging from 0 to 2% [17,18]. Following the excision of the tumor the eyelid should be reconstructed by standard oculoplastic procedures and should be performed expeditiously.…”

Cryosurgery during Imiquimod (Immunocryosurgery) for Periocular Basal Cell Carcinomas: An Efficacious Minimally Invasive Treatment Alternative

“…It is worth noting that contact of imiquimod with the ocular surface is generally safe and the substance has been successfully applied directly on conjunctival actinic keratoses for their treatment [20]. On the other hand, in the past decades cryosurgery has been extensively employed to treat pBCC and it has even been proposed as a tissue-sparing, first-line therapy for selected, mostly smaller (<1 cm in maximal diameter) [20,21,22,23] or well-circumscribed pBCC [24]. Finally, with immunocryosurgery healing is generally excellent (fig.…”

Oculoplastic aspects of ocular oncology

“…[33][34][35] It is useful for treating patients who are unfit for surgery or have multiple lesions requiring treatment, for example, basal cell naevus syndrome. The tumour is frozen to À 30 1C to induce cryodestruction, with either a cryoprobe or liquid nitrogen spray, using a double freeze-thaw technique and protecting the globe.…”