O'Halloran Louise, Smith Harvey, Vinciullo Carl
Department of Dermatology, Royal Perth Hospital, Perth, Western Australia, Australia.
Department of Dermatology, Oxford Day Surgery and Dermatology, Perth, Western Australia, Australia.
Australas J Dermatol. 2017 May;58(2):106-110. doi: 10.1111/ajd.12432. Epub 2016 Jan 14.
BACKGROUND/OBJECTIVES: Periocular skin tumours pose management challenges with literature supporting a multidisciplinary approach. This retrospective review identifies trends in multidisciplinary management, ascertaining potential benchmarks for practice review.
A retrospective review of 720 patients with periocular tumours, treated with Mohs micrographic surgery (MMS) at a single free standing Day Surgery Facility between 2009 and 2012.
In all, 690 patients were included, with mean age 65 and slight male preponderance. Basal cell carcinoma was the most commonly excised tumour (85.4%) and lower eyelid most common tumour site (58%). Of the cases repaired by Mohs surgeons, 2% involved more than one cosmetic subunit, compared with 23% by oculoplastic surgeons. Of the cases repaired by MMS, 1% had eyelid margin involvement, compared with 64% of the cases by oculoplastic surgeons. Mean preoperative lesion size for cases repaired by Mohs and oculoplastic surgeons was 0.5 cm . Mean postoperative defect size was smaller for cases repaired by Mohs surgeons compared with oculoplastic surgeons (1.5 and 1.9 cm ). Mean number of stages was less for Mohs surgeon repairs (n = 1.5) compared with oculoplastic surgeon repairs (n = 1.9). Cases repaired by oculoplastic surgeons were more often combination repairs.
This study identifies potential benchmarks for Mohs surgeons when reviewing or establishing a periocular Mohs surgery practice and for doctors referring periocular tumours for surgical removal. These include the proportion of periocular cases managed jointly and the location, size of defect and number of stages involved in tumors repaired by Mohs surgeon alone compared to those repaired by oculoplastic surgeons.
背景/目的：眼周皮肤肿瘤的治疗颇具挑战，文献支持采用多学科方法。本回顾性研究旨在确定多学科管理的趋势，为实践评估确定潜在基准。
对2009年至2012年期间在一家独立日间手术机构接受莫氏显微外科手术（MMS）治疗的720例眼周肿瘤患者进行回顾性研究。
共纳入690例患者，平均年龄65岁，男性略占多数。基底细胞癌是最常切除的肿瘤（85.4%），下眼睑是最常见的肿瘤部位（58%）。在莫氏外科医生修复的病例中，2%涉及多个美容亚单位，而眼整形医生修复的病例中这一比例为23%。在MMS修复的病例中，1%有眼睑边缘受累，而眼整形医生修复的病例中这一比例为64%。莫氏外科医生和眼整形医生修复病例的术前病变平均大小为0.5厘米。与眼整形医生相比，莫氏外科医生修复病例的术后缺损平均尺寸更小（分别为1.5厘米和1.9厘米）。莫氏外科医生修复的平均阶段数少于眼整形医生（分别为1.5和1.9个阶段）。眼整形医生修复的病例更常采用联合修复。
本研究为莫氏外科医生在评估或建立眼周莫氏手术实践时以及为转诊眼周肿瘤进行手术切除的医生确定了潜在基准。这些基准包括联合管理的眼周病例比例，以及与眼整形医生修复的肿瘤相比，仅由莫氏外科医生修复的肿瘤的位置、缺损大小和涉及的阶段数。
