Recurrence rates of basal cell carcinoma of the periocular skin: what to do with patients who have positive margins after resection.

OBJECTIVE: To determine the recurrence rates of basal cell carcinoma of the periocular skin in patients who were in the following 3 groups after pathologic analysis: Mohs frozen sections (negative margins); permanent sections with positive tumor margins; and permanent sections with negative tumor margins at the time of primary surgical removal. DESIGN: The study is a retrospective chart review. PARTICIPANTS: We identified 385 patients who underwent surgery for basal cell carcinoma. The surgery was performed by a single surgeon between January 1, 1995 and January 1, 2005. METHODS: The patients were divided into 3 groups: (i) Mohs frozen sections with margins negative for tumor; (ii) permanent sections with margins negative for tumor; (iii) permanent sections with margins positive for tumor. The recurrence rates of basal cell carcinoma were compared. RESULTS: The recurrence-free rate was 92% for the group that had had Mohs frozen-section, 87% for the group that had had permanent sections with negative margins, and 80% for the group that had had permanent sections with positive margins at 170 months follow-up time. We found that the only predictor of recurrence rate was younger age (hazards ratio (HR) = 0.97 95%; CI 0.94, 0.99; p = 0.021). CONCLUSIONS: The results showed a statistically significant difference in the recurrence-free rate in the 3 groups. A minimum of a 3-year follow-up is recommended in patients who have had basal cell carcinomas removed; the average time to recurrence was approximately 3 years.

Indications for orbital imaging by the oculoplastic surgeon.

OBJECTIVE: To determine the indications for ordering orbital imaging and the indications for ordering CT versus MRI by oculoplastic surgeons and to assess the correlation between surgeon's clinical indications for imaging and the radiologist's diagnosis. DESIGN: Retrospective review of imaging requisitions and radiology reports. PARTICIPANTS: Patients of 4 oculoplastic surgeons who required CT or MRI scans. METHODS: Imaging requisitions and radiology reports of patients from 4 oculoplastic surgeons were reviewed to determine the indication for ordering a CT or MRI scan between March 2006 and March 2009. The indications were then compared with the radiologist's diagnosis. RESULTS: A total of 735 patients were included: 449 (61.1%) female and 286 (38.9%) male, with an average age of 50.1 years and an age range of 7 months to 93 years. Of these patients, a total of 632 CT and 223 MRI scans were ordered, 135 of which were follow-up scans. CONCLUSIONS: The most common indication for CT scan was thyroid disease, followed by orbital tumors and then inflammatory disease, while the most common indication for MRI scan was orbital tumors, followed by inflammatory disease and then thyroid disease. CT scans were more commonly ordered than MRI, largely for trauma and to rule out orbital foreign body.