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JD Hsuan, C Collins, MJ Potts, RA Harrad; Small Margin Excision for Basal Cell Carcinoma of the Ocular Adnexa: Five Year Follow-up Results . Invest. Ophthalmol. Vis. Sci. 2002;43(13):3037.
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Purpose: To determine the complication and recurrence rates of nodular basal cell carcinomas (BCC) of the ocular adnexa which have been excised with small margins with delayed repair. Methods: Patients diagnosed with adnexal BCCs underwent excision with narrow, 2mm margins. Repair of the defect was delayed for 2 days to allow histological confirmation of complete excision of the tumour, using paraffin sections. This method was simpler than Moh’s technique, and was devised as an alternative to the traditional approach with 3-4mm margins and primary repair, to maximise preservation of normal tissue. This facilitated reconstruction, whilst ensuring complete removal of the tumour. Morpheic type lesions were not included as they have poorly defined limits and require excision with wide margins or Moh's technique. Patients were followed on a long-term basis to identify any complications or recurrences. Results: Five year follow-up data was available for 32 patients. Five patients required more than one excision before histological clearance was confirmed. Reconstructive techniques included direct closure with or without lateral cantholysis (13), advancement/rotation flaps (9), free skin grafts (6), free tarsal grafts (2) Hughes repair (1) and laissez-faire(1). There were no recurrences of the tumour. Complications included wound dehiscence in one and trichiasis in one. These occurred early and were thought to be related to the reconstructive technique rather than the use of small margin excision or delayed repair. Conclusion: The results demonstrate that small margin excision with delayed repair is a safe and efficient method of managing BCCs of the ocular adnexa. Normal tissue is preserved allowing the use of less radical reconstructive surgery without resorting to Moh's labour intensive micrographic technique. If histological clearance is not obtained at first, further excision is straightforward as the margins are undisturbed.
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