The Importance of Frozen Section-Controlled Excision in Recurrent Basal Cell Carcinoma of the Eyelids

Abstract

Objectives: To show the importance of frozen section-controlled excision to avoid the re-recurrence of recurrent basal cell carcinoma (BCC) of the eyelids.Materials and Methods: Thirty-five cases who underwent eyelid tumor excision in different centers and were admitted to our clinic with recurrent eyelid tumors. Recurrent tumors were resected by excision 1-2 mm from the tumor’s visible margin and sent to pathology for frozen section examination. Eyelid reconstructions with flap and graft were performed after confirming that the surgical margins were negative.Results: Twenty-one (60%) of our patients were male and 14 (40%) were female. Median age of our group was 63.4±14.2 years. Excision and sending the excised material for frozen section control was performed once for 11 patients, twice for 12 patients, 3 times for 8 patients and 4 times for 4 patients to confirm that the surgical margins were clean. All pathology samples were reported as BCC. All patients had eyelid reconstruction with flap and graft. Recurrence was detected in 2 patients (5.7%) during 1 to 8 years (mean 4.3 years) of follow-up and those patients were reoperated; no recurrence was detected in the remaining 33 patients (94.3%).Conclusion: Frozen section control can provide low re-recurrence rate in patients with recurrent BCC of the eyelids.

Characteristics and factors related to eyelid basal cell carcinoma in Saudi Arabia

“…In the current study, BCC was most commonly located in the lower lid and medial canthus, a finding similar to that of studies carried out in other countries, probably due to corneal light reflection onto the lower lid, associated with chronic irritation of chemical or physical factors related to the tears. [ 7 8 9 16 21 22 ] The upper lid is rarely affected likely due to protection conferred by the brow. [ 8 ]…”

“…However, the most common clinical presentation of BCC is nodular or nodular with a central rodent ulcer because of the overlying ulceration. [ 17 22 ] The pigmented BCC, which is considered a type of nodular BCC, was present in 15.5% of our patients probably because pigmented BCC is common in dark-skin complexion individuals[ 5 ] as it is usual in the Middle East. However, pigmented types were the least common for others who studied population of the same region.…”

“…Some lesions can clinically simulate other entities as morphea form of BCC may simulate chronic blepharitis being important to observe the absence of lashes which is a characteristic feature in malignant tumors. [ 22 ]…”

“…Surgical excision with FS analysis ensures unaffected surgical margins and is considered the gold standard procedure to treat large BCCs. [ 2 22 ] However, intraoperative FS analysis extends surgical time, increases cost, and requires the presence of an experienced pathologist at the medical center. [ 22 ] FS analysis is strongly recommended for more aggressive tumors and clinical and histological subtypes that are likely to have incomplete excision or recurrent tumors, reducing the chance of a subsequent recurrence.…”

“…[ 2 22 ] However, intraoperative FS analysis extends surgical time, increases cost, and requires the presence of an experienced pathologist at the medical center. [ 22 ] FS analysis is strongly recommended for more aggressive tumors and clinical and histological subtypes that are likely to have incomplete excision or recurrent tumors, reducing the chance of a subsequent recurrence. [ 8 22 24 ] When the lesion is small, circumscribed with well-defined margins, FS analysis can be avoided.…”