Diagnosis of aggressive subtypes of eyelid basal cell carcinoma by 2-mm punch biopsy: prospective and comparative study

Clinical Results of Punch Biopsy for Various Eyelid Disorders in the Office Setting

Purpose: To introduce punch biopsy, which can be easily performed in an outpatient setting, and to evaluate its clinical usefulness.Methods: A retrospective study was performed in 33 patients with atypical eyelid disorders who underwent punch biopsy.Results: This study included 33 eyes (33 patients; male:female = 12:21) with a mean age of 57.27 ± 19.12 years. There were 19 (57.6%) right eye, 14 (42.4%) left eye, 15 (45.5%) upper eyelid, and 18 (54.5%) lower eyelid lesions. The biopsy approaches were percutaneous and transconjunctival in 24 (72.7%) and nine (27.3%) eyes, respectively. Benign and malignant lesions were found in 21 (63.6%) and 12 (36.4%) eyes, respectively. The benign lesions included chalazion (52.4%), acute and chronic inflammation (23.8%), acanthosis (4.8%), and ectopic cillia (4.8%), and were treated conservatively by intralesional steroid injections or incision and drainage. The malignant lesions included sebaceous carcinomas (33.3%), squamous cell carcinomas (25%), and basal cell carcinomas (16.7%), with various treatments, including surgical resections, chemotherapy, and radiation therapy.Conclusions: Punch biopsy is a safe and quick procedure that can easily be performed in the office setting for patients who require a pathologic diagnosis for eyelid diseases, including malignancies. It may be useful for diagnosis and treatment planning.

Periocular basal cell carcinoma results and surgical outcome during a 5-year period in a larger Danish population

Background

To report tumour pathology, surgical procedure, complication rates and overall outcome of periocular basal cell carcinoma (BCC) in the Department of Ophthalmology at Sygehus Lillebaelt, Southern Denmark Region over a 5-year period.

Methods

Medical records for all patients who underwent surgery for periocular BCC between January 2016 and December 2020 were reviewed. All tumours were excised with a 3 mm margin beyond the clinically apparent delimitation of the tumour and analysed by frozen section histological examination. Paraffin sections were subsequently examined for a final histopathological diagnosis. Patient age, gender, date of resection, former cancer history, referring unit and follow-up time were recorded. Furthermore, histological subtypes identified from biopsy and resection, lesion location, lesion diameter, free margin after the first operation, lacrimal punctum involvement, reconstructive techniques and complications were also recorded.

Results

A total of 242 surgical excisions from 237 patients were recorded. The mean age was 69.7 ± 12.6 with women significantly predominant compared to men (1.8:1, p < 0.0001, binomial test). The mean tumour diameter was 4.29 mm (range 0.5–20 mm). The most common location and histological subtype was the lower eyelid and nodular BCC respectively (64.9% and 74.0% of cases). In 17.4% of the patients, the initial resection margin on the frozen section histology was not free of tumour cells and the risk was significantly greater for BCC subtypes considered aggressive in terms of growth pattern (morphea form, infiltrative and micronodular features) as compared to non-aggressive BCC subtypes (nodular and superficial) (p = 0.002, X²). In 239 (98.8%) of the patients, the BCC was found to be radically removed after final histopathological examination.

The sensitivity of identification of aggressive subtypes of periocular BCC in biopsies was 47.7%. No recurrences were found during the 5-year period.

Conclusion

This study demonstrated a tendency towards more women than men being diagnosed with periocular BCC. The initial biopsy performed for all patients underestimated the aggressiveness of BCC in almost half of the cases while aggressive BCC subtypes were more likely to need further resection after frozen section compared to non-aggressive subtypes.

The immunoexpression of MMP-1 and MMP-13 in eyelid basal cell carcinoma

Basal cell carcinoma (BCC) is the most frequent human malignancy and at the same time the most frequent periocular malignancy, representing almost 80% of all non-melanoma skin cancers and 90% of eyelid cancers. The study included 50 cases of eyelid BCC, out of which 41 were nodular BCC (NBCC) and nine were infiltrative BCC (IBCC), with various Breslow scores (BS) and primary tumor (pT) category. We analyzed the immunoexpression of matrix metalloproteinases (MMPs) 1 and 13 in the tumoral epithelial component (TEC) and inflammatory stromal component (ISC) of BCC in relation to the two histopathological parameters. The immunoreaction for MMP-1 was identified in 41 (82%) cases and for MMP-13 in 46 (92%) cases both in the TEC and ISC of both types of BCC. The statistical analysis revealed that both collagenases had positive/high scores significantly associated with advanced BS. For MMP-1, there were statistical associations in TEC related to IBCC and high pT category, while MMP-13 only revealed statistical association in ISC with high pT. The presence of collagenase MMP-1 and MMP-13 expression in a high number of cases, both in TEC and ISC, confirms their intervention in the tumor progression and proposes these MMPs as potential targets in antineoplastic therapy.

Nonmelanoma Skin Cancer at Critical Facial Sites: Results and Strategies of the Surgical Treatment of 102 Patients

Background

To evaluate the surgical treatment results of a consecutive series of patients with nonmelanoma skin cancer in critical facial regions such as the nose, lip, eyelid, ear, forehead, cheek, and chin.

Methods

This was a prospective observational cohort study evaluating the surgical treatment results of 102 patients with nonmelanoma skin cancer who underwent surgical excision and required some type of reconstruction. The reconstruction strategy used, histological type and margins, aesthetic result, and complications were evaluated.

Results

The most common facial site was the nose (48.01%), followed by the eyelid, ear, cheek, forehead, and lip. The most frequently used type of reconstruction was the advancement flap (30.39%), followed by transposition flap (27,45%), rotation flap (14.70%), and grafts (10.78%). Basal cell carcinoma was the most frequent histological type, accounting for 90.19% of the sample, with 54.90% of these cases being of the nodular subtype. Disease-free margins were obtained in 94.11% of the patients, and only one patient presented compromised margins and underwent marginal extension. A good cosmetic result was found in 93.13% of the participants.

Conclusion

Surgical treatment can provide excellent oncological, functional, and cosmetic results in the treatment of patients with nonmelanoma skin cancer at critical facial sites.