Predicting the Surgical Margin of Resection in Periocular Cutaneous Neoplasms and the Significance of Reconstruction Following Mohs Micrographic Surgery

Abstract

Standard 3 mm to 4 mm MOR for BCCAs, and 5 mm MOR for SCCAs could result in an unacceptable risk of tumor recurrence if the surgical margins are not examined histologically. With increasing preoperative tumor size, there is an increase in the MOR required for BCCA and SCCA, supporting that large tumors require a greater MOR.

A practical decision‐tree model to predict complexity of reconstructive surgery after periocular basal cell carcinoma excision

“…[21][22][23] One could argue that conventional surgery could result in smaller defects but for pBCC, standard surgical margin is often inadequate with unacceptably high recurrence rates. 11 To the best of the authors' knowledge, this is the first tool for a risk gradation system and it was predictive of complexity of reconstructive surgery after tumour excision. The follow-up of patients was excellent, allowing for accurate longitudinal assessment of tumour growth and post-surgical complexity.…”

“…However, Mohs surgery has been well validated for the treatment of pBCC . One could argue that conventional surgery could result in smaller defects but for pBCC, standard surgical margin is often inadequate with unacceptably high recurrence rates …”

“…3,4 While pBCCs account for only up to 10% of all non-melanoma skin cancers of the face, 5-10 the surgery to remove these tumours is inherently more complex due to its anatomical location, potential detrimental effect on vision and aggressiveness compared to other types of tumours. 11 Due to the unpredictable growth of pBCC, 12,13 factors that predict the complexity of post-surgical complexity are not well studied. Complex cases require additional time and resources.…”

A model of interdisciplinary care

“…Mohs micrographic surgery (MMS) for periocular basal cell carcinoma (BCC) has shown recurrence rates as low as 0% for primary and 7·8% for recurrent BCC on 5‐year follow‐up . Standard surgical excision (SSE) achieves margin clearance in as few as 25% of periocular tumours due to tumour‐specific factors and more rapid growth, but also due to surgical conservatism given the complexity of reconstruction. The importance of complete surgical excision of primary tumours cannot be overstated.…”

Mohs micrographic surgery combined local flaps in treatment of EMPD: A retrospective case

“…Mohs micrographic surgery (MMS) is a tissue-preserving surgical procedure that is used for the treatment of recurrent, infiltrative, and high-risk skin cancers. The normal tissue of patients can be preserved as much as possible due to the operator can directly observe the margin of the lesion using a microscope during MMS, so the risk of local recurrence is reduced (Mann, Al-Niaimi, Cooper, & Ghura, 2016;Sines, Polomsky, & Dutton 2016;Tidwell, Mayer, Malone, Schadt, & Brown, 2015).…”