OCULOPLASTIC RECONSTRUCTION FOLLOWING MOHS SURGERY

Purpose Mohs micrographic surgery has been advocated as the optimal ma nagement of nonmelanoma skin cancer in the periocular region. It is a technique that is ideally suited to the removal of skin rumours with a contiguous growth pattern such as basal cell carcinoma and squamous c ell carcinoma, allowing examination of 100% of the surgical margin. As a result of this total margin control, the technique offers an unsurp assed cure rate combined with maximal preservation of normal tissue. F ollowing excision of a periocular tumour by a Mohs surgeon, the result ing defect usually requires reconstruction. Our objective was to deter mine whether the size of defect produced by Mohs surgery and the type of reconstruction required differed from the results,ve would have exp ected from standard surgery with a 3 mm excision margin. Methods A Moh s surgery service with a combined dermatological and oculoplastic appr oach was set up in Manchester in 1994. We reviewed 60 of our patients who underwent Mohs surgery and compared the size of defect produced as well as the type of reconstruction required with the results rye woul d have predicted for standard excisional surgery with a 3 mm margin. R esults Although a minority of patients required larger reconstructions than would have been anticipated (20%), many had smaller reconstructi ons than we had predicted (37%). This latter group often had important structures preserved, and therefore had the benefit of less extensive reconstructive surgery. Conclusions Excision of a periocular tumour b y Mohs surgery may occasionally identify extensive subclinical tumour extension and so produce an unexpectedly large defect for reconstructi on. Many patients, however, require less extensive reconstructive surg ery than would have been predicted. This produces benefits in terms no t only of improved cosmesis and eyelid function, but also reduced oper ating theatre costs.