title: High rate of incomplete resection after primary excision of eyelid BCC: multi-staged resection rarely needs more than two procedures.
abstract: OBJECTIVE
  Small, well-demarcated, biopsy-proven periocular basal cell carcinomas (BCC) are often excised in a single stage with immediate reconstruction when histology or location is considered low-risk. We investigated margin clearance in patients undergoing primary excision and immediate reconstruction (PER) versus multi-staged fast paraffin excision (MSE) and reviewed risk factors for incomplete excision.
  
  
  METHODS
  Retrospective, interventional, comparative case series of periocular BCCs excised over a 3-year period (2006-2008).
  
  
  RESULTS
  Ninety consecutive patients with periocular BCC (average age 77 ± 10.1 years, 60% females) were included. 39% (35/90) underwent PER with the remainder managed by MSE (55/90, 61%). Patients undergoing MSE had larger lesions (38% > 10 mm versus 23% PER) which were more likely to involve the medial canthus (25 versus 11% PER). Incomplete histological clearance was noted in 34% (12/35) patients after PER. Only 3/55 (5%) needed third stage of excision in the MSE group with final incomplete excision in two cases (3.6%) that did not undergo a third stage excision. No significant risk factors were found likely to predict residual BCC overall, after first excision stage. Subgroup analysis for patients undergoing PER showed multiple lesions as the only statistically significant factor for incomplete excision.
  
  
  CONCLUSIONS
  This study shows an unacceptably high rate of incomplete resection with primary excision and repair using a standard 3 mm margin. The majority of lesions undergoing multi-stage excision required no more than two stages for complete removal. Multi-stage excision with histological confirmation of clear margins prior to reconstruction is recommended for routine management of all periocular BCC.
authors.affiliation: Birmingham and Midland Eye Centre, Birmingham, UK. anjukadyan@btinternet.com
authors.forename: Anju
authors.initials: A
authors.lastname: Kadyan
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Edmunds
authors.forename: Kwesi N
authors.initials: KN
authors.lastname: Amissah-Arthur
authors.forename: Omar M
authors.initials: OM
authors.lastname: Durrani
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002280:Basal Cell Carcinoma / Q000473:pathology / Q000601:surgery*; D016009:Chi-Square Distribution; D005142:Eyelid Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D013508:Ophthalmologic Surgical Procedures / Q000379:methods*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012086:Reoperation; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D016896:Treatment Outcome