Inkster C, Ashworth J, Murdoch J R, Montgomery P, Telfer N R, Leatherbarrow B
Manchester Royal Eye Hospital, UK.
Eye (Lond). 1998;12 ( Pt 2):214-8. doi: 10.1038/eye.1998.51.
Mohs micrographic surgery has been advocated as the optimal management of nonmelanoma skin cancer in the periocular region. It is a technique that is ideally suited to the removal of skin tumours with a contiguous growth pattern such as basal cell carcinoma and squamous cell carcinoma, allowing examination of 100% of the surgical margin. As a result of this total margin control, the technique offers an unsurpassed curve rate combined with maximal preservation of normal tissue. Following excision of a periocular tumour by a Mohs surgeon, the resulting defect usually requires reconstruction. Our objective was to determine whether the size of defect produced by Mohs surgery and the type of reconstruction required differed from the results we would have expected from standard surgery with a 3 mm excision margin.
A Mohs surgery service with a combined dermatological and oculoplastic approach was set up in Manchester in 1994. We reviewed 60 of our patients who underwent Mohs surgery and compared the size of defect produced as well as the type of reconstruction required with the results we would have predicted for standard excisional surgery with a 3 mm margin.
Although a minority of patients required larger reconstructions than would have been anticipated (20%), many had smaller reconstructions than we had predicted (37%). This latter group often had important structures preserved, and therefore had the benefit of less extensive reconstructive surgery.
Excision of a periocular tumour by Mohs surgery may occasionally identify extensive subclinical tumour extension and so produce an unexpectedly large defect for reconstruction. Many patients, however, require less extensive reconstructive surgery than would have been predicted. This produces benefits in terms not only of improved cosmesis and eyelid function, but also reduced operating theatre costs.
莫氏显微外科手术被认为是眼周区域非黑色素瘤皮肤癌的最佳治疗方法。该技术非常适合切除具有连续生长模式的皮肤肿瘤，如基底细胞癌和鳞状细胞癌，可对手术切缘进行100%检查。由于能完全控制切缘，该技术具有无与伦比的治愈率，同时能最大程度保留正常组织。在莫氏外科医生切除眼周肿瘤后，所产生的缺损通常需要修复。我们的目的是确定莫氏手术产生的缺损大小以及所需的修复类型是否与我们预期的标准手术（切缘为3毫米）的结果不同。
1994年在曼彻斯特建立了一个采用皮肤科和眼整形联合方法的莫氏手术服务机构。我们回顾了60例接受莫氏手术的患者，并将产生的缺损大小以及所需的修复类型与我们预测的切缘为3毫米的标准切除手术的结果进行了比较。
尽管少数患者需要比预期更大的修复（20%），但许多患者所需的修复比我们预测的要小（37%）。后一组患者通常保留了重要结构，因此受益于范围较小的重建手术。
通过莫氏手术切除眼周肿瘤偶尔可能会发现广泛的亚临床肿瘤扩展，从而产生意外大的缺损需要修复。然而，许多患者所需的重建手术比预期的要少。这不仅在改善美容效果和眼睑功能方面有好处，而且还降低了手术室成本。
