Elsevier

Ophthalmology

Volume 111, Issue 4, April 2004, Pages 631-636
Ophthalmology

Original article
The Australian Mohs database, part II: Periocular basal cell carcinoma outcome at 5-year follow-up

Presented at: American Academy of Ophthalmology Annual Meeting, October, 2002; Orlando.
https://doi.org/10.1016/j.ophtha.2003.11.004Get rights and content

Abstract

Objective

To report the outcome with 5-year strict follow-up (only cases where 5-year follow-up is available) of all patients with periocular basal cell carcinoma (BCC) treated with Mohs' micrographic surgery (MMS) in Australia between 1993 and 1996.

Design

Prospective, noncomparative, multicenter, interventional case series.

Methods

A prospective series of 819 patients, undergoing MMS for periocular BCC over a 3-year period (1993–1996).

Inclusion criteria

Periocular BCC referred for MMS.

Main outcome measures

Recurrence, site, size, prior occurrence, defect size, histologic subtype, and presence of perineural invasion.

Results

Eight hundred nineteen patients had 257 (54%) lower eyelid, 195 (41%) medial canthus, and 22 (5%) upper eyelid BCCs. The most common histologic subtypes were nodulocystic (43%) and infiltrating (30%) (P = 0.0003). Sixty-eight percent were primary and 32% were recurrent tumors. Five-year follow-ups for cases between 1993 and 1996 were available in 347 (42%) cases. There were 7 recurrences (2.0%; exact 95% confidence interval [CI]: 0.82%–4.1%), 5 of which were at the medial canthus and all of which were previously recurrent, with up to 3 recurrences before MMS. Previous recurrence (P<0.0001), infiltrating (5) or superficial (2) histologic subtype (P = 0.0882), and medial canthal site were the main predictors of recurrence after MMS. There were no recurrences for primary BCC, and the 5-year recurrence for previously recurrent BCC was 7.8% (exact 95% CI: 3.2%–15.4%).

Conclusion

The Australian MMS database is the largest prospective nationwide series of periocular BCC managed by MMS. The strict 5-year recurrence rates of 0% and 7.8% for primary and recurrent tumors, respectively, confirm MMS as the treatment of choice for periocular BCC.

Section snippets

Materials and methods

A prospective, noncomparative, multicenter, interventional case series of patients with periocular BCC treated with MMS in Australia and monitored by the Skin and Cancer Foundation is reported. The criteria for selection were all cases of periocular BCC treated by MMS between 1993 and 1996. Tumors treated outside this period were excluded from this study. The methods used are described in part I of this study report.6 Recurrence at 5-year post-MMS follow-up was recorded for all cases, in

Results

During 1993 to 1996, 819 periocular BCCs were treated by MMS. To identify any obvious differences in cases treated during this period, clinical features were compared with the remaining cases in the overall series.6 There was no difference in gender (P = 0.2795); however, patients treated during 1993 to 1996 were younger than those treated after 1996 (mean difference: 3.3 years; 95% CI: 1.6–4.9). More medial canthal BCCs (53% vs. 41%) and fewer lower eyelid BCCs (44% vs. 54%) were treated

Discussion

The Australian MMS database is the largest prospective nationwide series of high-risk periocular BCCs managed by MMS, using fresh-frozen tissue sections and with a strict 5-year follow-up. We found no recurrences for primary BCCs and a recurrence rate of 7.8% (exact 95% CI: 3.2%–15.4%) for previously recurrent BCCs. Strict 5-year recurrence rates are reported—that is to say, the recurrence rate for only those cases for which 5-year follow-up data were available. That the recurrence rate is so

Acknowledgements

The authors thank the Skin and Cancer Foundation Australia and the participating Mohs surgeons for providing the data for this research. The Mohs surgeons involved were Drs Phillip Artemi, Timothy Elliott, John Coates, Brian De'Ambrosis, Gregory Goodman, Irene Grigoris, Michelle Hunt, Dudley Hill, Shyamala Huilgol, David Leslie, Robert Paver, Shawn Richards, William Ryman, Robert Salmon, Margaret Stewart, Howard Studniberg, Carl Vinciullo, and Perry Wilson. The authors also thank Kristyn

References (30)

  • Malhotra R, Huilgol SC, Huynh NT, Selva D. The Australian Mohs database, part I: periocular basal cell carcinoma...
  • N.R Telfer et al.

    Guidelines for the management of basal cell carcinoma

    Br J Dermatol

    (1999)
  • F.E Mohs

    Micrographic surgery for the microscopically controlled excision of eyelid cancers

    Arch Ophthalmol

    (1986)
  • P Robins et al.

    Mohs surgery for periocular basal cell carcinomas

    J Dermatol Surg Oncol

    (1985)
  • R.L Anderson

    Mohs' micrographic technique

    Arch Ophthalmol

    (1986)
  • Cited by (0)

    Manuscript no. 230068.

    View full text