[Management of eyelid tumors: general considerations]

Complications and Recurrences after Excision and Reconstruction of Eyelid Tumours

INTRODUCTION

The eyelids are a common site for skin tumours and account for 5-10% of all skin tumours. Treatment is mainly surgical and aims to preserve the anatomical structure of the eyelid, its function and not least its aesthetic appearance.

AIM

Presentation of recurrence and complication rates of tumour-related eyelid surgery in a cohort of 450 tumours.

RESULTS

Analysis of a cohort of 450 tumours operated on revealed 13 (2.8%) operations with recurrences and 32 (7%) with complications. The statistical significance of recurrences was observed for the involved and uninvolved ciliary margin. At the temporal canthus, 23.1% of recurrences occurred compared to 7.7% at the medial canthus. SGC has the highest recurrence rate. Complications include the following: ectropion, dehiscence, gross cicatrix with normal function, retraction, post-radiation damage, sub-graft haemorrhage and graft rejection.

CONCLUSIONS

The recurrence rate of eyelid tumours is lower than that of complications. The choice of surgical technique determines the frequency of complications and histological control of the excised tissue, as well as the frequency of recurrences.

A Modified Bifurcated Periosteal Flap for Simultaneous Reconstruction of Upper and Lower Lateral Canthal Tendons

A bifurcated periosteal flap is useful for simultaneous reconstruction of the upper and lower lateral canthal tendons. The original technique harvested the flap horizontally from the frontal process of the zygoma, which mostly resulted in an insufficient flap length because of the narrowness of the zygoma. Here, the authors report the use of a modified bifurcated periosteal flap, raised from the superolateral orbital rim. The lower flap was positioned to slant inferiorly to create a downward slope of the lower eyelid for smooth lacrimal drainage by gravity. The authors applied this technique to 2 patients and obtained good cosmetic results without complications such as entropion, ectropion, lower-eyelid sagging, epiphora, or lateral canthal deformity.

[What size of surgical margins for carcinoma of the eyelid?]

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.