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Saaquib Bakhsh, Jenna M Kim, Abraham Gomez, Geoffrey Gladstone; The incidence of residual tumor and recurrence after staged excision of small periocular basal cell carcinoma. Invest. Ophthalmol. Vis. Sci. 2019;60(9):3556.
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In patients with biopsy-proven, small basal cell carcinoma (BCC) of the eyelid, residual BCC can be clinically difficult to identify. The authors report a cohort of patients referred to a single oculoplastic surgeon for full excision of residual BCC and reconstruction of the eyelid. We describe the rate of residual BCC and the rate of recurrence in this cohort.
We performed retrospective chart review of 38 patients between 2009 and 2014 with margin-positive BCC of the eyelid with no clinically identifiable residual BCC. After pentagonal-wedge resection of suspected areas, histopathologic studies of re-excised tissues were performed, and the incidence of histologic residua was calculated. Recurrence of BCC on follow up was recorded.
Six of 38 patients (15.8%) had residual BCC on re-excision though without positive margins, while the rest had no microscopic evidence of BCC. No subjected needed further re-excision. The mean follow up was 26.8 weeks (SD 26.7). One patient in the entire cohort (1 of 38; 2.6%) developed biopsy-proven recurrence of BCC at 32 weeks. This one patient was not one of the six patients who had malignant cells at re-excision.
The incidence of residual malignant cells at re-excision of incompletely-excised, small BCC was 15.8% in this cohort. This is consistent with the incidence of histologically-confirmed residua in another study of periocular BCCs of various sizes. Oculoplastic surgeons tasked with re-excision of incompletely-excised, clinically-indistinct BCC should counsel patients on the low yield of the procedure but emphasize the importance of long-term follow up for recurrence even with negative margins or absence of residual malignant cells at re-excision.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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