Risk Factors for Orbital Exenteration in Periocular Basal Cell Carcinoma

I read with great interest the recent report by Iuliano and associates describing orbital exenteration in patients with orbital invasion of periocular basal cell carcinoma. A striking finding was that the authors could achieve negative tumor margins in only half of the patients who underwent exenteration (12 of 24 patients). Typically, exenteration has a surgical goal of attaining local tumor control via negative margins when offered to patients with orbital extension of malignancy. Thus, seeing half of the patients in the study with positive margins seems high. There is no mention in the article if any of these patients underwent exenteration with a surgical goal of tumor debulking for cosmetic disfigurement, which is sometimes offered for such patients. I am also curious as to whether these 12 cases were multidisciplinary surgical cases with such services as neurosurgery and otolaryngology used as a best attempt to achieve negative surgical margins. Additionally, was frozen section intraoperative margin control used in these patients in an attempt to achieve negative margins? These are important points to address because the surgical goal in most instances during exenteration for orbital malignancy is complete tumor excision with negative tumor margins, and if this does not seem plausible after careful interpretation of preoperative orbital radiography, it is my belief that a treatment method other than surgery should be offered.

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Jan 12, 2017 | Posted by in OPHTHALMOLOGY | Comments Off on Risk Factors for Orbital Exenteration in Periocular Basal Cell Carcinoma

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