Punch biopsy in the management of periocular basal cell carcinomas.

AIM

The aim of this study was to define the role of punch biopsy in the management of periocular basal cell carcinomas.

PATIENTS AND METHODS

A case-note review was performed on 24 patients undergoing punch biopsies for eyelid lesions. Depending on the clinical diagnosis, two groups were identified: Group A with periocular basal cell carcinomas and Group B with periocular lesions other than basal cell carcinoma. The histopathological diagnosis based on punch biopsy specimens was compared with (a) the clinical diagnosis and (b) the final histopathological diagnosis based on the excision biopsy specimen.

RESULTS

The punch biopsy confirmed the diagnosis of basal cell carcinoma in 14 of 16 cases in Group A and 2 of 8 cases in Group B. Clinical characteristics when used alone in the diagnosis of basal cell carcinoma had a positive predictive value of 87.5% and a negative predictive value of 75%; hence a sensitivity of 87.5% and a specificity of 75%. Appropriate surgical intervention (two-stage tumour excision and lid reconstruction) was performed in 2 of 8 cases (25%) not initially clinically diagnosed as basal cell carcinomas. Unnecessary surgical intervention was avoided in 2 of 16 cases (12.5%) clinically diagnosed as basal cell carcinomas. The final histopathological result in all cases undergoing surgical excision confirmed the diagnosis of basal cell carcinoma made from the punch biopsy tissue specimens.

CONCLUSION

The results suggest that punch biopsy provides an accurate histopathological diagnosis prior to commencing definitive surgical management and may be a useful tool in the management of periocular basal cell carcinomas.