[Basal cell epithelioma of the eyelids].Ann Dermatol Venereol. 1988; 115(6-7):669-78.AD
The purpose of this study of 36 patients was to assess the oncological, functional and cosmetic results of surgery in the treatment of basal cell carcinoma of the eyelid and to compare them with those obtained with other possible therapeutic methods.
MATERIAL AND METHODS
We report a series of 36 cases of histologically proven basal cell carcinoma principally located on the lower eyelid and the inner canthus. 27 p. 100 of the patients had previously been treated and presented with a recurrent tumour. Mean age was 61 years. Minimum follow-up was 5 years. Reinforced and potentiated local anaesthesia was given in most cases. Tumoral excision was complete in 31 patients, insufficient or borderline in 5 patients. Intraoperative extemporaneous biopsy was performed in 8 p. 100 of the cases. Repair was carried out by direct suture or by grafting, the flap being simple or combined with a mucosal or chondromucosal graft. The lacrymal passages were destroyed in 5 cases and were not reconstructed in 4 of them. There was no postsurgical therapy.
As regards the malignancy itself, the recurrence rate was 6 p. 100 and affected patients who had previously been treated. The cure rate was 100 p. 100 in patients for whom surgery was the first treatment, and 94 p. 100 in the totality of patients. Functionally, there was one case of ectropion, and epiphora developed in 7.4 p. 100 of the cases. In this series epiphora was associated with destruction of the lacrymal passages in only one patient. Satisfactory cosmetic results were obtained in 85 p. 100 of the cases, bearing in mind that the assessment was necessarily subjective.
Treatments of basal cell carcinoma are numerous. We shall analyze their results, advantages and drawbacks compared with those of surgery. Cryotherapy raises technical problems of execution which are responsible for an excessively high recurrence rate. Chemotherapy has recently been enriched with the introduction of Solcoderm, but the follow-up is still too short. Electrocoagulation gives good oncological results, but it can only be used for small lesions. Radiotherapy (contact, penetrating or semi-penetrating X-ray therapy, electron therapy) has a cure rate of 95 p. 100 and gives acceptable cosmetic results. However, it requires numerous sessions, cannot be repeated if it fails and complicates surgical treatment; in the long term, it carries a risk of radiodystrophy. Its functional and ocular complications have been estimated at 9 p. 100. Epiphora is present in 2 to 19 p. 100 of the cases.(ABSTRACT TRUNCATED AT 400 WORDS)