Khandwala Mona A, Lalchan Shelly-Anne, Chang Bernard Y P, Habib Maged, Chakrabarty A, Cassells-Brown Andy
Department of Ophthalmology, Leeds General Infirmary, Belmont Grove, Leeds, UK.
Orbit. 2005 Dec;24(4):243-7. doi: 10.1080/01676830590952630.
Surgical excision of periocular skin cancer allows for optimum control in terms of tumour recurrence. Although Mohs' technique gives the best outcome, it is not widely available. Processing paraffin sections is slower but histologically superior to Mohs' frozen sections. We report the results of using a standard paraffin section (non-Mohs') technique to confirm histological clearance.
A retrospective study between 1/6/95 and 1/6/99 of all consecutive patients who had excision of periocular cancer was performed. All patients had surgical excision of the tumour with a 3-mm margin. Rapid (24-hour) paraffin sections were done and reconstruction performed if histological clearance was confirmed. If tumour was still present, a further 3-mm margin was excised at the appropriate edge(s) before reconstruction took place.
This study yielded 93 basal cell carcinomas (BCCs) of which 86 were of primary origin and 7 were recurrent tumours. The tumour characteristics were as follows: 88% nodular BCCs, 82% had a maximum surface measurement less than or equal to 10 mm, 39.8% were inner canthal and 49.5% were localised to the lower lid. In the 30 (35.4%) cases that required further excision based on the initial histological reports, tumour was seen in only four (11.4%) cases. Overall histological clearance for primary BCCs was achieved in 81/86 (94.2%) cases. There was only one late recurrence at 4 years and 5 months. Among recurrent BCCs, there was one recurrence (12.5%) and this was despite histological clearance having been reported.
For primary BCCs the recurrence rate in this study was low and comparable to that following Mohs' technique. This approach, using routine pathological facilities, therefore offers a viable technique for managing periocular BCCs.
手术切除眼周皮肤癌在肿瘤复发方面能实现最佳控制。虽然莫氏手术技术效果最佳，但应用并不广泛。处理石蜡切片速度较慢，但在组织学上优于莫氏手术的冰冻切片。我们报告了使用标准石蜡切片（非莫氏手术）技术确认组织学切缘阴性的结果。
对1995年6月1日至1999年6月1日期间所有连续接受眼周癌切除手术的患者进行回顾性研究。所有患者均接受肿瘤切除，切缘为3毫米。若组织学切缘阴性得到确认，则进行快速（24小时）石蜡切片并进行重建。若仍有肿瘤存在，则在重建前在适当边缘再切除3毫米切缘。
本研究纳入93例基底细胞癌（BCC），其中86例为原发肿瘤，7例为复发性肿瘤。肿瘤特征如下：88%为结节型BCC，82%最大表面尺寸小于或等于10毫米，39.8%位于内眦，49.5%局限于下睑。在最初组织学报告显示需要进一步切除的30例（35.4%）病例中，仅4例（11.4%）发现有肿瘤。原发性BCC的总体组织学切缘阴性率为81/86（94.2%）。仅在4年零5个月时有1例晚期复发。在复发性BCC中，有1例复发（12.5%），尽管报告显示组织学切缘阴性。
对于原发性BCC，本研究中的复发率较低，与莫氏手术技术后的复发率相当。因此，这种利用常规病理设施的方法为处理眼周BCC提供了一种可行的技术。
