Wednesday, August 30, 2006

BCC of Eyelid

This 43 yo man has a one year history of a lesion of the left lower lid. It measures 8 mm in diameter.
Biopsy from "X" confirms "nodular BCC."
Question: What is best therapy?
1) Mohs
2) Mohs + closure by ophthalmic plastic surgeon
3) Ophthalmic plastic surgeon handle all
4) Another approach

Cada vendador allabe sus agujas.
Every peddler praises his needles.


  1. If the patient is in my country,I will do curretage followed by light diathermy.The only feared complication is contracture which is a far possibility if the procedure is done by experienced hand
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  2. I would probably choose Mohs surgery followed by closure by oculoplastics. As it is around the eyes, you do not want to risk a permanent ectropion which will damage the cornea. I don't know what "light diathermy" is -- can someone tell me?

  3. At our institution, the patient would undergo Mohs surgery followed by oculoplastic repair. Mohs surgery offers the lowest recurrence rate, especialy in locations with a high risk of recurrence such as the eyelid.

    Diathermy is electrocautery. We would not treat this patient with curettage followed by electrodessication because the recurrence rates are higher (all sites 7.7% C&E vs 1.0% Mohs per J Dermatol Surg Oncol 1989; 15(3):315). Recurrence is even more likely in this patient given the eyelid location. Curettage of the eyelid is difficult because the eyelid will need to be retracted so that curettage can be carried out against the bony rim possibly leading to slightly less complete curettage of the superior portion of the lesion. Furthermore, because of the fragility of eyelid skin, normal eyelid skin may be removed with curettage. So one cannot dependend on the curette to help define the lesion margin.


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