Clinical study and risk factors for recurrence of basal cell carcinoma of the eyelid: Results of a Tunisian series and review of the literature

Purpose. - To report our results of treatment of eyelid basal cell carcinomas and evaluate risk factors for recurrence. Patients and methods. - We carried out a retrospective study of 172 basal cell carcinomas in 168 patients, treated in the Ophthalmology department of Sousse University Medical Center (Tunisia), from January 1987 to July 2012. Initial treatment was surgical excision with a standard margin of 4 mm or a single radiation treatment. When excision was incomplete, we had the choice between further excision, radiotherapy or a "wait and see'' approach. Mean follow-up in our study was 11.5 months with range from 1 month to 14 years. Results. - We treated 169 tumors in 165 patients, with three patients out of 168 having refused the proposed treatment. Primary radiotherapy was performed in 4 cases in patients presenting with large tumors and refusing disfiguring surgery. For the 165 other tumors (95.9%), surgical excision was performed. Surgical margins were clear in 106 cases (64.2%) and positive in 37 cases (22.4%). No residual tumor was noted in 2 cases for which biopsy was initially performed, and margins could not be visualized in 20 cases (12.1%) due to the small size or fragmentation of the specimen. For the incompletely excised tumors, we performed a second excision in three cases (8%), radiotherapy in 11 cases (29.7%) and a "wait and see'' approach in 22 cases (59.4%). The recurrence rate was 6.9%, with a mean time of 32.8 months until recurrence. Conclusion. - Basal cell carcinoma represents the most frequent malignant tumor of the eyelids. Surgery remains the standard treatment. The "wait and see'' approach offers an interesting option for the management of incompletely excised basal cell carcinoma, especially with low risk lesions. (C) 2014 Elsevier Masson SAS. All rights reserved.