Eyelid Tumour Excision: Frozen Sections Versus Mohs’ surgery

The aim of treatment of basal cell carcinoma (BCC), squamous cell carcinoma (SCC) and other malignancies of the eyelids is to fully eradicate the tumour by surgical excision. Frozen section controlled (FSC) surgical excision of eyelid tumours, followed by histopathological confirmation with permanent fixed section, is usually the preferred technique for many oculoplastic surgeons and pathologists. Tumours are excised with a cold blade or scissors with at least 2 to 10 mm margins clinically free from neoplasia, according to the tumour type, and frozen section examination of surgical margins is employed for the histologic confirmation prior to eyelid defect reconstruction. Mohs micrographic surgery (MMS) is a procedure that involves the surgical removal of clinically visible tumour, together with a thin layer of normal-appearing tissue around and beneath the lesion. Then, the resected tissue is frozen and microscopically examined. If the malignancy is present at the edges or under the surface, additional resection is performed. It preserves most of normal tissue while obtaining clear margins and is useful for tumours located in the canthal areas that require adequate tissue conservation to maintain satisfactory cosmetic and functional results. Where these facilities are unavailable, a wider excision is suggested with margin control with permanent histology and delayed reconstruction after histological confirmation of clear margins.