The Importance of Frozen Section-Controlled Excision in Recurrent Basal Cell Carcinoma of the Eyelids

Interest of frozen section procedure in skin tumors other than melanoma

BACKGROUND

Skin tumors are common. Recommended treatment in most cases is surgery, with margins adapted. Except in the case of simple resection and suture, it is necessary to know the status of the margins before reconstructing the defect. A one-stage technique is possible with frozen section analysis, which gives the surgeon an intraoperative assessment of resection quality. The aim of our work is to study the reliability of the frozen section procedure.

METHOD

A retrospective study included 689 patients who underwent surgery for skin tumor (excluding melanoma) between January 2011 and December 2019 at the University Hospital of Caen, France.

RESULTS

In 639 patients (92.75%), the frozen section analysis found healthy margins. There were 21 cases of discrepancy between the frozen section analysis and final histology. Infiltrating and scleroderma-like basal cell carcinomas showed a significantly higher frequency of affected margins on frozen section analysis (p < 0.001). The tumor size and location played a significant role in the margin status.

CONCLUSION

In our department, the frozen section procedure is the reference examination indicating immediate flap reconstruction. The present study demonstrated its interest and overall reliability. However, it is to be used according to histologic type, size, and location.

Periorbital reconstructive techniques following Mohs micrographic surgery or excisions: a systematic review

There are many articles in the literature on periorbital reconstruction after Mohs micrographic surgery (MMS) or surgical excision, however, the literature lacks a comprehensive systematic review of these reports. We performed a systematic review of published data on periorbital defect reconstruction to identify trends in the literature. A comprehensive search of eight databases was performed. To be included in the study, articles had to be published in English between 2005 and 2020 and contain repair data for MMS or excision defects in the periorbital region. Studies with less than four patients, literature or systematic reviews, and abstract-only publications were excluded. Data extracted from eligible articles included the authors' medical specialties, study design, subject number and demographics, defect characteristics, procedure type, reconstructive methods, complications, outcome measures, and method of outcome assessment. 53 studies met the inclusion criteria. The first and last authors' specialties were ophthalmology (47%), plastic and reconstructive surgery (23%), dermatology (13%), otolaryngology (4%), or were multi-specialty collaborations (13%). Only 5 of the studies were prospective. Defects were located on the lower eyelid (55%), medial canthus (31%), upper eyelid (8%), lateral canthus (4%), or a combination of these sites (2%). Reconstructive methods were reported for 3678 cases and included linear repair (18%), advancement flap (8%), rotation flap (5%), transposition flap (3%), island pedicle flap (1%), unspecified local skin flap (21%), skin graft (23%), secondary intention (4%), tarsoconjunctival flap (3%), and combined reconstruction techniques (13%). Thirty-three of 53 articles specified the periorbital subunit for each reconstructive technique that was employed. Among these 33 articles which allowed for correlation between defect location and reconstructive technique, the most utilized repair method for lower eyelid defects was local skin flap. Defects on the upper eyelid or medial canthus were most frequently repaired with a skin graft. Forty articles commented on cosmetic outcomes, however, only 3 of these articles utilized a defined grading system, objective measurements, or independent reviewers to assess the cosmetic outcomes. The methods of reconstruction in this review were diverse, however, local skin flaps and grafts were the most utilized techniques. In future reports, increased reporting of reconstructive technique by defect location as well as increased use of standardized assessments of aesthetic outcomes can help strengthen this body of literature.

Clinicopathological Study of Meibomian Carcinoma of Eyelids - An Experience of Two Years in a Tertiary Care Center

PURPOSE

Meibomian carcinoma is a rare and aggressive malignant neoplasm of the eyelids. The clinical presentation often mimics benign conditions thereby making the diagnosis challenging. The aim of the study was to analyze cases of meibomian carcinoma, the specimens of which were received, in the past 2 years in the pathology department.

METHODS

This retrospective observational study was undertaken for 2 years and included 9 patients of meibomian carcinoma. For each case, detailed history and clinical findings were retrieved from the hospital records. Histopathological examination was undertaken in all cases after preparing hematoxylin and eosin-stained slides from tissue blocks preserved in the department.

RESULTS

The mean age of the patients was 55 ± 15 years. Six (66.7%) patients were females, and the other three (33.3%) were male. Following surgery, gross examination of the specimens revealed that the mean size of the excised tumors was 2.45 ± 1.45 cm. The tumors were classified based on histopathological features according to growth pattern, cell type, and cytoarchitecture. Most cases had lobular growth pattern (5, 55.6% cases), consisted of epidermoid cells (5, 55.6% cases), and exhibited infiltrative cytoarchitecture (8, 88.9% cases).

CONCLUSION

Early diagnosis of meibomian carcinoma is important to reduce mortality from the aggressive tumor. The knowledge of clinicopathological aspects of the tumors that were biopsied in the department of pathology in the past 2 years will help in diagnosis and management of such tumors in future.

Maintaining Quality of Life: Electrochemotherapy for Palliative Periorbital Malignancy

Electrochemotherapy has been used successfully for treatment of recurrent head and neck skin cancers and skin metastasis. It combines both electroporation and chemotherapy. The authors report 4 patients, who all had metastatic periorbital malignancy. These patients were palliative with widespread metastatic malignancy. All patients had either already had multiple procedures or declined surgical resection and preferred less involved measures. The authors report technique and outcomes. Patient 1: 83-year-old man with recurrent malignant melanoma (MM) nodules (BRAF negative) in the left medial orbit and medial canthal area after rhinectomy and previous resections. Patient 2: 72-year-old man with metastatic MM who developed painful and unsightly metastatic nodules on the right and left forehead and the left medial canthus. Patient 3: 93-year-old man with background of widespread multiple myeloma, considered palliative. He developed a left forehead SCC, apparent as a fungating ulcer, which caused significant pain due to perineural invasion. Patient 4: 91-year-old woman with recurrent metastatic sebaceous cell carcinoma of the left lower eyelid obstructing her vision. All patients experienced an improvement in their pain and quality of life. None of the patients developed any significant periorbital inflammation or adverse complications. Electrochemotherapy may be a useful palliative treatment for periorbital tumors. It improves pain and reduces tumor volume. It can be considered for tumors where palliative radiotherapy may be contraindicated.Electrochemotherapy is a useful palliative treatment for metastases to the periorbital area, improving pain and size of the tumors.

Characteristics and Factors Related to Eyelid Basal Cell Carcinoma in Saudi Arabia

PURPOSE:

Data on basal cell carcinoma (BCC) from the Middle East are deficient. We present the features and management outcomes for BCC over the last 36 years in Saudi Arabia.

SUBJECTS AND METHODS:

This retrospective chart review included BCC patients diagnosed and treated at Saudi Arabia between 1980 and 2016. Data were collected on patient demographics, clinical and histopathological characteristics of the lesions, management, and follow-up.

RESULTS:

One hundred and twenty-six patients with BCC were included in this study. The incidence of BCC in Saudi Arabia is 0.8 cases a year. The median age of the patients was 71 years. BCC affected 58.9% of males. The lower lid was the most common site of occurrence (52.7%). Clinically, BCC was most commonly recognized as a mixed lesion (41.1%) and 50.4% were histologically nodular. Risk factors for poor prognosis included tumor localization in the medial aspect of the lid, tumor size > 5 mm, histological subtype being ulcerative or morphea forms, affected margins, and recurrent lesions.

CONCLUSION:

BCC is a rare condition in Saudi Arabia. The clinical features and histopathology of BCC in Saudi Arabia are similar to the patterns observed in other regions of the world. Early detection and timely management mitigates the extensive destructive ocular/orbital damage due to BCC and results in better patient outcomes.