Relapses after surgical treatment of ocular adnexal basal cell carcinomas: 5-year follow-up at the same university centre.

Purpose: To define the efficacy of surgical resection of ocular adnexal basal cell carcinoma and to analyse possible risk factors, we determined relapse rates on a yearly basis postintervention in a cohort of patients that were treated in our hospital under comparable conditions.

Methods: A total of 366 such cases that were admitted for treatment between 2002 and 2006 were followed prospectively once yearly and tumour size and localization, histological type, functional and cosmetical outcome and relapses were recorded. In cases when the primary resection margins were not free, further resections were performed until the resection margin was histologically assessed tumour free on the basis of paraffin-fixed tissue sections. Lid reconstruction was carried out as direct closure, Tenzel rotation flap, tarsomarginal transplants or tarsoconjunctival flaps (Hughes), inversed rotation flaps, tarso marginal grafts, Cutler Beard flaps, free skin grafts, rhomboid, glabella or advancement flaps. Relapse-free survival 3, 4 and 5 years postoperatively was estimated by the Kaplan-Meyer method.

Results: Three relapses after 3 years and two further relapses after 5 years were recorded. An additional relapse was documented 6 years postoperatively. Accordingly, the relapse-free survival was 0.99 (95% CI 0.98-1.00) after 3 years, 0.99 (95% CI 0.97-1.00) after 4 years and 0.97 (95% 0.95-0.98) after 5 years. The relapses occurred in previously relapsed tumours and in tumours of morphea type. Primary nodular basal cell carcinomas did not relapse in this study.

Conclusions: Based on these studies and in comparison with published relapse rates after cryotherapy, surgical resection appears to be superior to the latter procedure.