Abstract
Background. Periorbital basal cell carcinoma (BCC) is considered a high risk case because it is associated with high rate of recurrence and complication. Superpulsed CO2 laser with intraoperative pathologic assessment could be an alternative and appropriate treatment for periocular lesions where Mohs micrographic surgery is not available. Objective. To evaluate the efficacy of superpulsed CO2 laser therapy with intraoperative pathologic assessment on periocular BCC involving eyelash line. Method. This follow-up study was performed on 20 patients with a total of 21 BCC lesions that were pathologically documented. Firstly, debulkation of tumoral mass was done by curettage. Then, irradiation and intraoperative pathologic evaluation were done by concurrent CO2 laser. The patients were followed up for a period of 36 months. Results. Out of 21 lesions, the nodular type accounted for 15 (71.4%) lesions, and 12 (57.1%) lesions were seen in the lower lid as the most common clinical type and site involvement. Twenty BCC lesions (95.2%) were treated after one session. Damage to eyelash was seen in 2 (10%) patients, but ectropion and other complications were not seen in any patient. Conclusion. Treatment with superpulsed CO2 laser and intraoperative pathologic evaluation for periorbital BCC lesions much close to conjunctiva could be an effective method with minimal complications without major danger of recurrence. This modality can be used with care in the inner canthus and high risk pathologic lesions.
Highlights
Basal cell carcinoma (BCC) is the most common malignant tumor of periorbital area, it rarely results in death [1,2,3]
Several optional treatments have been suggested for periorbital basal cell carcinoma (BCC) such as chemotherapy [7, 8], traditional surgical excision [9,10,11], photodynamic therapy [12, 13], Mohs micrographic surgery [14,15,16], and laser ablation [17,18,19,20]
Biopsy was done in the patients that were clinically suspected of periorbital BCC extended to eyelash line
Summary
Basal cell carcinoma (BCC) is the most common malignant tumor of periorbital area, it rarely results in death [1,2,3].BCC is associated with disfiguration and very high cost especially in large lesion, recurrent forms, aggressive pathologic subtype, poorly defined tumor, immunosuppression, and high risk locations such as periorbital region [1, 4, 5].The periorbital BCC is the most common cause of orbital exenteration, especially in recurrent BCCs, infiltrative pathologic subtype, and medial canthal lesions [6].Several optional treatments have been suggested for periorbital BCC such as chemotherapy [7, 8], traditional surgical excision [9,10,11], photodynamic therapy [12, 13], Mohs micrographic surgery [14,15,16], and laser ablation [17,18,19,20].The use of superpulsed mode of CO2 laser compared with its traditional one results in precise destruction of lesion with minimum damage to the normal surrounding tissue due to minimal thermal diffusion; it is associated with low risk of hypertrophic or atrophic scar [21].This study was carried out to evaluate the treatment outcome and complications of the superpulsed mode CO2. Superpulsed CO2 laser with intraoperative pathologic assessment could be an alternative and appropriate treatment for periocular lesions where Mohs micrographic surgery is not available. To evaluate the efficacy of superpulsed CO2 laser therapy with intraoperative pathologic assessment on periocular BCC involving eyelash line. Treatment with superpulsed CO2 laser and intraoperative pathologic evaluation for periorbital BCC lesions much close to conjunctiva could be an effective method with minimal complications without major danger of recurrence. This modality can be used with care in the inner canthus and high risk pathologic lesions
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