Investigating basal cell carcinoma recurrence and outcomes following surgical excision at Broomfield hospital ophthalmology department, United Kingdom

Purpose Our current practice involves 2 years follow up after periocular BCC excision. This audit aims to investigate outcomes of: BCC recurrence rate while under follow up after histologically proven complete excision. Histological findings in cases of biopsy of suspected recurrent BCC Methods Retrospective identification of samples sent to histopathology by a single Oculoplastic consultant with suspected or confirmed BCC between 01/01/16–30/04/19. Clinic letters identified the duration from surgical excision to latest follow up and any suspicion of recurrence. Where initial surgery was incomplete, or recurrence suspected clinically, secondary surgery results were checked to determine whether residual BCC was reported. Initial diagnostic incising biopsy results were excluded. Results Of 115 samples, 51 were excluded as per criteria. Of the remaining 64 patients, 56 patients were reviewed post‐operatively with no suspicion of recurrence in timeframe seen (1–>24 months). Of 64 patients, 8 (12.5%) warranted secondary surgery within 2 years: 5 indicated by reported margin involvement (7.8%); 3 indicated by clinical suspicion (4.7%). This audit did not identify any cases of BCC recurrence. Residual BCC was identified on one deeper resection indicated by histopathology. Patients may continue to be risk assessed, and follow‐up preserved for: persistent marginal involvement; aggressive BCC sub‐type; pre‐disposition for BCC; immunosuppression; higher risk initial BCC site (e.g. medial canthus or orbital invasion). Conclusions No cases of BCC recurrence were identified within this cohort. Re‐excision of involved margin tends not to a show positive result. Minimal residual BCC may have been destroyed during the initial surgical cauterisation or by the immune system. We propose to discharge patients following complete excision of low risk BCCs from the periocular area with advice to seek referral with any new lesions following self‐examination.