|Title||Three year disease-free outcome in all non-melanomoutous skin cancers excised with 1mm margins and same-day reconstruction in a district general hospital|
|Submitted by||Jonathan Roos|
|Review Result||rapid fire presentation|
The periocular area is a high-risk area for skin cancer development and deeper spread. Excision with standard Mohs techniques can lead to large surgical defects, compromise adnexal structures such as the canaliculi, as well as breach anatomical barriers to invasion such as the orbital septum. Here we describe the successful use of reduced margin excision and same-day reconstruction using frozen section analysis of all non-melanoma skin cancers in the periocular area.
We reviewed the electronic records of all patients with non-melanoma skin cancer treated in the oculoplastic service over a 7 year-period from 2009 to 2016 to ensure full three-year follow up. Tumours were excised with a 1mm margin and sent for frozen section margin clearance with two marking sutures. Reconstruction occurred on the same day once margins were determined to be clear. To ensure good theatre utilisation other oculoplastic cases are interspersed on the list whilst histology is awaited. All samples were also subsequently processed routinely in paraffin.
162 patients had skin cancer excisions, of which 85% were basal cell carcinomas (nodular 39%, infiltrative 6), 10% squamous cell carcinomas and 5% comprised other pathologies, including benign pathology and viral papillomas. There were no recurrences after 3 years of follow-up. Cosmetic results were excellent and patients satisfaction high.
Previous studies have shown long-term recurrence-free outcomes principally for patients with basal cell lesions excised with 3mm margins using en face frozen section margin clearance. This data extends these findings to all non-melanoma skin cancers and shows that smaller margins are equally safe. For the periocular area, frozen section clearance with reduced margins may offer advantages over Mohs micrographic surgery without reduced safety.
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