Management of Periocular Basal Cell Carcinoma With Modified En Face Frozen Section Controlled Excision

Wong, Vincent; Marshall, Jodie A; Whitehead, Kevin J.; Williamson, Richard; Sullivan, Tim

doi:10.1097/00002341-200211000-00008

Cited by 123 publications

(86 citation statements)

References 43 publications

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“…28 In the 5-year follow-up in the present study, most recurrences in patients with negative margins occurred in the third year (50% of all recurrences in cases of completely excised tumors), while in incompletely excised tumors most recurrences occurred in the second and third years following surgery (40% of all recurrences with positive margins in each year). These data are in agreement with findings reported in the literature.…”

Section: Discussionsupporting

confidence: 42%

Does incomplete excision of basal cell carcinoma of the eyelid mean tumor recurrence?

Jankovic

Kovačević

Visnjic

et al. 2010

An. Bras. Dermatol.

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Introduction: Basal cell carcinoma is the most common tumor of the eyelid. In this region, reconstruction is complex and damage to healthy tissue should be minimal. Objective: To define the relationship between margin clearance at excision and the recurrence rate of basal cell carcinoma of the eyelid. Methods: This prospective study was conducted with 111 patients submitted to surgery for basal cell carcinoma of the eyelid between 2001 and 2003 and followed up for a period of five years. The patients were evaluated according to age, tumor site, recurrence rate and margin clearance at excision. Results: No significant association was found between incomplete tumor excision and recurrence except in patients under 56 years of age, female patients and in the case of tumors of the medial canthus. Conclusion: A risk of recurrence in incompletely excised basal cell carcinomas of the eyelid was only confirmed in younger patients, females and for tumors of the medial canthus. Keywords: Basal cell carcinoma; eyelid; recurrence.Resumo: Introdução: O carcinoma basocelular é o tumor mais comum entre os tumores das pálpebras. Nesta região, a reconstrução é complexa e recomenda-se que haja perda mínima de tecido saudável. Objetivo: Para definir a relação entre margem livre de tumor na excisão e taxa de recidiva do carcinoma basocelular das pálpebras. Métodos: Este estudo prospectivo incluiu 111 pacientes operados para remoção de carcinoma basocelular das pálpebras no período de 2001 a 2003, com acompanhamento subsequente de 5 anos. Os pacientes foram avaliados de acordo com a idade, localização do tumor, taxa de recidiva, e margem livre de tumor na excisão. Resultados: Não se encontrou associação significativa entre a excisão incompleta do tumor e casos de recidiva, exceto em pacientes com idade inferior a 56 anos, pacientes do sexo feminino e em tumores do canto medial. Conclusão: Um risco maior de recidiva de carcinoma basocelular das pálpebras com excisão incompleta foi confirmado estatisticamente apenas em pacientes mais jovens, em mulheres, e nos tumores do canto interno.

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Section: Discussionsupporting

confidence: 42%

Does incomplete excision of basal cell carcinoma of the eyelid mean tumor recurrence?

Jankovic

Kovačević

Visnjic

et al. 2010

An. Bras. Dermatol.

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“…Although recently Mohs' micrographic surgery has been hailed as the best method of removing BCC with minimal recurrence, 8,[11][12][13] it may be too costly 14 and time consuming to be used for all periocular BCC. 15 In addition, it may not be available in every hospital.…”

Section: Discussionmentioning

confidence: 99%

“…With frozen section, the pathologist dissects a 0.5 to 1.0 mm margin of tissue for cryosectioning. 12 All fresh-frozen section are further analysed in formalin subsequently as the literature suggests frozen section may be more prone to inaccurate interpretation than formal paraffin section. Difference between the findings on fresh-frozen section and formal histology section was noted in two of our patients.…”

Section: Discussionmentioning

confidence: 99%

“…Equally, a large proportion of patients do not wish to be followed-up 41 and in some clinics there is a high rate of nonattendance. 42 Prolonged follow-up of all patients with periocular BCC 12,43,44 is both costly and inconvenient. Our views concur with the current evidence-based recommendations from the BAD (British Association of Dermatologists) guidelines advising that long-term hospital-based follow-up after treatment of BCC for patients other than those with Gorlin's syndrome is neither necessary nor recommended.…”

Section: Eyementioning

confidence: 99%

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5 Years review of periocular basal cell carcinoma and proposed follow-up protocol

Brown

Bamford

et al. 2012

Eye

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In all, 67% were nodular BCC and 45.4% located in the lower eyelid. The main outcome measure was the recurrence rate. None of the patients with primary nodular BCC suffered recurrence. The recurrence rate for primary morphoeaform BCC following complete excision is 3.8%. In total, 8.1% of patients had several lesions simultaneously whereas 7.8% patients had BCC in multiple locations subsequently (metachronous). Three patients who had previously recurrent BCC (rBCC) treated elsewhere or not using this method had orbital/lacrimal drainage system involvement requiring exenteration. Conclusion We recommend that patients with a single, completely excised primary solid or nodular BCC can be discharged after one 6-monthly review, although they should be instructed to monitor for the development of further lesions. The incidence of recurrence for primary morphoeaform BCC is 3.8% and for rBCC is 3.6% over 5 years and these patients should stay under review for this period.

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“…Diagnosis of BCC is usually made clinically, which must then be confirmed microscopically. The treatment option for BCC consists of Mohs' micrographic-controlled or en face frozen section controlled surgical excision with later routine pathology sections, cryotherapy, radiotherapy and medical treatment (12). MMS is said to be the "gold method" at some institutions (13,14) that previous studies showed that excision of BCC with pathological evaluation of the margins, i.e.…”

Section: Discussionmentioning

confidence: 99%

A Diagnostic Accuracy Comparison Between Tzanck Smear Test and Frozen Section Examination in Basal Cell Carcinoma

et al. 2017

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Background: Mohs' micrographic surgery is a suitable treatment and frozen section (FS) examination is the "gold standard" of surgical margins in tumoral skins. This study compared the diagnostic accuracy between the Tzanck smear test (TST) and frozen section (FS) examination for margin control in surgery for basal cell carcinoma (BCC). Methods: Fifty-nine patients with basal cell carcinoma (BCC) were included. The tumor was excised and the Tzanck smear test (TST) was taken for Papanicolaou staining (Pap staining) and reconfirmation of tumoral cells. Then a dermatologist took margins of tumoral mass. TST was taken from the margins and sent to the dermatopathologist for Pap staining. After dying, each marked fragment was sectioned separately with cryostat. Finally, diagnostic accuracy of TST compared with FS examination was analyzed. Results: The sensitivity and specificity of TST for the evaluation of margin were 0.28 and 0.95; whereas positive and negative predictive values were 0.54 and 0.85, respectively. Positive and negative likelihood values were 5.36 and 0.76, respectively. Diagnostic accuracy was 0.82. The kappa coefficient of agreement between the two methods was 0.28 (P < 0.001). Conclusions: Positive likelihood value and specificity of TST for the evaluation of margin were high; therefore, TST can be suitable in the diagnosis of BCC, but due to low sensitivity and kappa coefficient, TST alone cannot be a suitable alternative method compared to the FS examination for margin control in BCC.

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Management of Periocular Basal Cell Carcinoma With Modified En Face Frozen Section Controlled Excision

Cited by 123 publications

References 43 publications

Does incomplete excision of basal cell carcinoma of the eyelid mean tumor recurrence?

Does incomplete excision of basal cell carcinoma of the eyelid mean tumor recurrence?

5 Years review of periocular basal cell carcinoma and proposed follow-up protocol

A Diagnostic Accuracy Comparison Between Tzanck Smear Test and Frozen Section Examination in Basal Cell Carcinoma

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