Mouriaux F, Stefan A, Coffin-Pichonnet S, Verneuil L, Rousselot P
Service d'ophtalmologie, CHU de Rennes, 2, rue Henri-Le-Guilloux, 35000 Rennes, France.
Service de dermatologie, CHU de Caen, avenue de la Côte-de-Nacre, 14003 Caen, France.
J Fr Ophtalmol. 2015 Feb;38(2):154-8. doi: 10.1016/j.jfo.2014.11.003. Epub 2015 Jan 27.
Traditional surgical treatment of non-melanoma skin cancer includes excision with adjacent surgical margins, such "safety" margins theoretically leading to lower recurrence rates. Thus, some authors favor a clinical excision margin of 4mm for basal cell carcinoma and 6mm for squamous cell carcinoma. However, such "safety" margins cannot be applied in all cases of eyelids tumors for anatomic and functional reasons, because such recommendations may lead to severe ocular complications, even loss of the globe. Thus, in order to mitigate these issues in oculoplastic surgery, excision with reduced margins is proposed, either with frozen sections or with traditional pathologic analysis and secondary reconstructive surgery several days later. The purpose of this article is to demonstrate that it is possible to reduce surgical margins while respecting "safety" from tumor recurrence, in order to preserve ocular integrity. The most appealing technique is frozen section of the margins, corresponding to "slow-Mohs" micrographic surgery.
非黑色素瘤皮肤癌的传统手术治疗包括切除肿瘤及其周边的手术切缘，理论上这种“安全”切缘可降低复发率。因此，一些作者主张基底细胞癌的临床切除切缘为4毫米，鳞状细胞癌为6毫米。然而，由于解剖学和功能方面的原因，这种“安全”切缘不能应用于所有眼睑肿瘤病例，因为这样的建议可能会导致严重的眼部并发症，甚至眼球丧失。因此，为了在眼部整形手术中缓解这些问题，有人提出采用缩小切缘的切除方法，可通过术中冰冻切片或传统病理分析，并在几天后进行二期重建手术。本文的目的是证明在确保肿瘤复发“安全”的同时，有可能缩小手术切缘，以保持眼部的完整性。最具吸引力的技术是对切缘进行冰冻切片，这相当于“慢速莫氏”显微外科手术。
