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To summarise the management and outcomes of surgical treatment of non-BCC periocular skin cancers treated in a District General Hospital.

Retrospective review of all surgically treated non-BCC tumours between 2012 and 2017 by a single oculoplastic consultant.

52 cases of non-BCC tumours were identified from histology. Mean age was 75 (range 48-95), with 27 males and 25 females. The majority of cases were squamous cell carcinoma (SCC) (36), followed by sebaceous cell carcinoma (6), lentigo maligna (4), lentigo maligna melanoma (2), malignant melanoma (2), and Kaposi sarcoma (2). 22 patients (42%) had a history of skin cancer elsewhere. Complete histological clearance was achieved with staged surgery prior to reconstruction in 49 cases. Of the remaining 3 patients, 1 was unfit for further surgery, and 2 had advanced disease at presentation and subsequently died (1 from SCC, 1 from malignant melanoma). Despite surgical excision margins of 5mm for SCC and 10mm for lentigo maligna and malignant melanoma, histological clearance required an average of 1.7 excisions (range 1-4). 3 patients (1 SCC and 2 sebaceous carcinoma) required exenteration with locally invasive tumours at presentation. So far only one local recurrence has been observed in a patient who died shortly afterwards from other causes.r

Staged surgery is mandatory for non-BCC periocular tumours with histological clearance prior to reconstruction. Frozen sections are of insufficient quality for accurate histology in such cases. Lentigo maligna melanoma presents a significant challenge as multiple excisions are usually required and reconstruction may be delayed. With wide excision margins, a high cure rate may be achieved for these tumours.