Eyelid basal cell carcinoma

Abstract

This thesis discusses the aetiology, diagnosis and treatment of eyelid basal cell carcinomas (BCCs).To study UVR exposure in the periocular area, dosimeters were placed at 7 sites in the periocular region in a manikin and in two test subjects. The UVR exposure was compared with the location of 329 eyelid BCCs. No difference was found in UVR exposure to the upper and lower eyelids while BCCs were much more common on the lower eyelid (13:1). To study the ability of d-aminolevulinic acid (ALA)-induced fluorescence to delineate eyelid BCC, ALA was applied to the tumour area in 16 patients with eyelid BCCs subjected to Mohs micrographic surgery. The fluorescence intensity from the tumour area was higher than from the surrounding ALA-treated skin in most cases (10/12) of BCC. The specimens from the Mohs micrographic surgery were used to determine the superficial extension of the tumour. The size determined by fluorescence imaging agreed with the histopathologically identified size in 8 of 10 tumours. To evaluate cryosurgery treatment for well-outlined eyelid BCCs, 222 tumours were treated. The diameter of the tumours was 5-10 mm in 52%, 10-15 in 23% and 15 mm or more in 10%. The patients were followed prospectively for up to 10 years. No recurrence was observed during the follow-up period. The cosmetic results were generally excellent.Mohs micrographic surgery was used in the excision of 66 poorly demarcated eyelid BCCs. Biopsy specimens from the tumours were classified into one of four histopathological subtypes . The patients were followed prospectively and complications and interventions were registered. The mean number of excisions during the Mohs procedure needed to achieve radicality was 2.5 (median 2; range 1-6). Three recurrences occurred during the follow-up period, after one, four and six years, respectively. By treating well-outlined periocular BCC with cryosurgery and poorly demarcated tumours with Mohs micrographic surgery, it is possible to achieve a high cure rate (99% in this study), an excellent cosmetic result and preserved eyelid function in a cost-effective way.