Periocular Microscopically Controlled Surgery and Reconstruction Trends in Nonmelanoma Skin Malignancies: A Single Institution Retrospective Review

Abstract

Background: The periocular region is susceptible to numerous benign and malignant neoplasms. Periocular skin malignancies may present differently, behave more aggressively, and pose more management challenges than malignancies at other cutaneous sites. Extent of skin cancer is often difficult to assess prior to surgery. Microscopically controlled surgery (MCS) aims to assure complete removal of a malignancy with histological confirmation while preserving as much of the adjacent tissues as possible. This retrospective review distinguishes clinical-practice management trends in periocular nonmelanoma skin malignancies. Methods: Retrospective review of 37 medical records of patients with histology proven periocular nonmelanoma skin malignancies seen in Oculoplastic section of the Department of Ophthalmology at Hospital de l'Esperança - Hospital del Mar between July 2010 and January 2017. Results: Global mean age was 72 with a male: female ratio of 1. Basal cell carcinoma was the most commonly excised tumor (81%) and lower eyelid the most common tumor location (54%) followed by medial canthus (38%). MCS was performed globally in 65% of cases. During 2011-2012 period 38% of malignancies were treated with MCS. MCS was performed in 73% of cases during 2013-2014 and 2015- 2016 periods. Mean horizontal excision size was 13 mm. Flap and flap and graft combination were the most frequent reparation types (24% each). Conclusions: Microscopically controlled surgery for the management of periocular malignancies has increased in our hospital during 2011-2016. It confirms histopathological diagnosis and free margins of excision allowing periocular reconstruction on the same day. Microscopically controlled surgery safes healthy tissues which are essential in the eyelid and it decreases patients’ morbidity.