Periocular Mohs micrographic surgery in Western Australia 2009–2012: A single centre retrospective review and proposal for practice benchmarks

Abstract

Periocular skin tumours pose management challenges with literature supporting a multidisciplinary approach. This retrospective review identifies trends in multidisciplinary management, ascertaining potential benchmarks for practice review. A retrospective review of 720 patients with periocular tumours, treated with Mohs micrographic surgery (MMS) at a single free standing Day Surgery Facility between 2009 and 2012. In all, 690 patients were included, with mean age 65 and slight male preponderance. Basal cell carcinoma was the most commonly excised tumour (85.4%) and lower eyelid most common tumour site (58%). Of the cases repaired by Mohs surgeons, 2% involved more than one cosmetic subunit, compared with 23% by oculoplastic surgeons. Of the cases repaired by MMS, 1% had eyelid margin involvement, compared with 64% of the cases by oculoplastic surgeons. Mean preoperative lesion size for cases repaired by Mohs and oculoplastic surgeons was 0.5cm2 . Mean postoperative defect size was smaller for cases repaired by Mohs surgeons compared with oculoplastic surgeons (1.5 and 1.9cm2 ). Mean number of stages was less for Mohs surgeon repairs (n=1.5) compared with oculoplastic surgeon repairs (n=1.9). Cases repaired by oculoplastic surgeons were more often combination repairs. This study identifies potential benchmarks for Mohs surgeons when reviewing or establishing a periocular Mohs surgery practice and for doctors referring periocular tumours for surgical removal. These include the proportion of periocular cases managed jointly and the location, size of defect and number of stages involved in tumors repaired by Mohs surgeon alone compared to those repaired by oculoplastic surgeons.