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

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.