Table 1.
Favored surgical techniques for surgical management of periocular cutaneous malignancies.
| Favored surgical techniques | Basal cell carcinoma | Squamous cell carcinoma | Sebaceous cell carcinoma | Melanoma | Merkel cell carcinoma |
|---|---|---|---|---|---|
| Pre-operative map biopsy | – | – | Yes | – | – |
| Wide local excision | – | – | – | – | Yes (1-2cm margin) |
| Excision with frozen section margin control | Yes (especially for nodular varieties) | – | – | – | – |
| Staged excision with permanent fixation for margin control | – | – | – | Yes | – |
| Mohs surgery or other PDEMA techniques | Yes | Yes | Yes | Yes (needs “slow Mohs” technique with use of permanent fixation) | Yes |
| Sentinel lymph node biopsy | – | – | Yes (tumor diameter >10 mm or recurrence) | Yes (Breslow thickness >1.0 mm) | Yes |
Note that choice of surgical technique depends on tumor and patient factors, and more detailed algorithms may be found via the National Comprehensive Cancer Network (NCCN) website at www.nccn.org. Patients should be counseled on risks of progression or toxicity prior to planned surgery. Complex cases should be considered with a multidisciplinary approach of oculofacial surgeons, radiation and medical oncologists in accordance with patient’s preferences and goals.
PDEMA, peripheral and deep en face margin assessment