Growth of periocular basal cell carcinomas

Background Basal cell carcinomas (BCCs) are generally regarded as slow-growing tumours. There is a paucity of data on the rate of BCC growth and the impact of delayed excision. Objectives To measure the growth rate and assess the impact of delayed excision on the growth of periocular BCC (pBCC). Methods Patients referred to an oculoplastic service for excision of pBCC were recruited. The tumour dimensions and patient demographic data were recorded at the first specialist appointment (FSA). Measurement of the pBCC was repeated when the patient attended for tumour excision by Mohs micrographic surgery (MMS). Correlation analyses were performed to determine whether the histological subtype and patient factors affected the pBCC growth rates. Results The study included 112 patients and 115 pBCCs. The primary ethnicity was European with Fitzpatrick type I and II skin. The mean size of the pBCC at FSA was 8 x 6 mm (range 6-12 x 4-8 mm) with a mean area of 68.5 mm(2). The average waiting time for MMS was 157 +/- 87 days. The pBCCs grew at a mean rate of 11.2 mm(2) every 30 days. From the FSA to the MMS, a mean increase of 41.9 mm(2) was observed. Recurrent tumours, larger tumours at presentation and male sex were associated with a faster growth rate. Conclusions Periocular basal cell carcinomas can grow rapidly, and many have aggressive histological subtypes. Rapid growth is more likely in recurrent tumours, larger tumours and in men.