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Treatment options for basal cell carcinoma

The first step is to confirm the diagnosis of basal cell carcinoma histologically. Then the treatment for a BCC depends on its type, size and location, the number to be treated and the preference or expertise of the oculoplastic surgeon. Treatment of facial, eyelid and periocular basal cell carcinoma is usually surgical, although other non-surgical treatments may rarely be selected.

Surgical techniques:

Non-surgical techniques

Plastic / Oculoplastic / Oculofacial reconstructive surgery

The preferred treatment of basal cell carcinomas on the face is surgical, by a dermatologic or an oculoplastic surgeon. These surgeons often work together, the dermatologic surgeon excising (removing ) the tumour using Mohs' micrographic surgery and the oculoplastic or oculofacial surgeon repairing the defect or "hole" which has been created.

The main advantage of surgical excision is that excision margins can be examined histologically to check for tumour clearance. An excision margin of 4 mm around the tumour is recommended where possible. Around the eyes the oculoplastic surgeon has the best skills and experience with which to reconstruct the defect and restore function.

Oculoplastic Repair

Facial, peri-ocular and eyelid reconstruction is tailored to the individual patient, their age, mobility, whether they can see well with two eyes, the position, size and depth of the tumour and of its resultant defect after Mohs' micrographic excision.

The resultant wound or defect leaves a small soft tissue "hole" which is then repaired by either i) laissez faire (allowed to heal up by itself), ii) a small local tissue flap or iii) a skin graft.

Repair can be done on the same day as tumour excision or can be delayed for between one and 5 days before the repair. Sometimes Mohs' micrographic excision is not available and the tissue specimen has to be analysed by the histopathologist using conventional paraffin fixation and staining, which can take 48 hours or longer so repair is delayed.