Purpose

To evaluate outcomes following histopathologically incomplete excision of periocular basal cell carcinoma (BCC), focusing on margin status and the need for re-excision.

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Methods

A retrospective review was performed at a tertiary oculoplastic unit over four years. Patients undergoing standard excision of periocular BCC with a 3 mm clinical margin and paraffin histopathology were included. Mohs surgery cases were excluded. Complete excision was defined as margins >0.2 mm for nodular BCC and >1 mm for infiltrative BCC. Tumour site, subtype, margin status, re-excision findings, and follow-up outcomes were analysed.

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Results

A total of 442 patients were included. Complete excision at first surgery was achieved in 300 cases (67.9%), while 142 lesions (32.1%) were incompletely excised. Incomplete excision occurred predominantly in infiltrative BCC (71.2%), most commonly at the medial canthus and lower eyelid. Twelve patients with incompletely excised nodular BCC elected observation, with no recurrence at 3-year follow-up. Following re-excision, 90.1% of specimens showed no residual tumour, mainly in nodular BCC. All cases requiring multiple re-excisions (n=4) were infiltrative BCC.

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Conclusion

Histopathological incomplete excision of periocular BCC does not always indicate residual disease, particularly in nodular subtype lesions. Selected nodular BCCs may be safely observed, whereas infiltrative BCC is associated with persistent disease and repeated surgery, supporting a more aggressive surgical approach.

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Additional Authors

First name	Last name	Base Hospital / Institution
Mario	Farrugia	Leicester university hospitals
Joyce	Burns	Leicester university hospitals
Raghavan	Sampath	Leicester university hospitals

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