Management of periocular basal cell carcinoma with modified en face frozen section controlled excision

Purpose: To determine the rate of recurrence of basal cell carcinomas (BCCS) after modified en face frozen section-controlled excision in a high-risk population in Queensland, Australia. Methods: Retrospective, noncomparative interventional case series. A review was conducted of all patients with periocular BCCs examined between 1992 to 2001 in a tertiary oculoplastics practice. Basal cell carcinomas were surgically excised, and the recurrence rates under modified en face frozen section control, Mohs micrographic surgery, and no frozen section control were documented. Epidemiologic aspects of periocular BCC in Queensland, Australia were also studied. Results: In patients with primary BCCs, 0.71% (3 of 423 lesions) recurred when excised under frozen section control (mean follow-up, 2.6 years), At 5-year follow-up, the recurrence rate was 2.1% (2 of 97 lesions). Excision without frozen section control yielded a recurrence rate of 1.8% (2 of 113 lesions; mean follow-up, 2.6 years). There were 6 additional lesions, however, that were incompletely excised. At 5 years, the recurrence rate was 5%. Six patients had lesions removed with Mohs micrographic surgery. There were no recurrences after a mean follow-up of 1.7 years. Of 653 total lesions, 361 involved the right eye (55%). Most BCCs were on the lower eyelid (53%) and inner canthus (29%). Solid BCCs were the most common type (54%), followed by the infiltrative type (15%). The majority of complications were minor and caused no ocular damage. Conclusions: Carefully performed, modified en face frozen section controlled excision of periocular BCCs yields cure rates comparable to Mohs micrographic surgery at 5-year follow-up. Close communication with a skilled pathologist is essential to achieve these low recurrence rates. The fact that lesions involved the right periocular region more than the left may reflect greater sun exposure on that side from driving.