LASER MICROSURGERY FOR SUPERFICIAL T1-T2 BASAL-CELL CARCINOMA OF THE EYELID MARGINS

Background: Basal cell carcinoma (BCC), the most common malignancy of the eyelid margins, poses therapeutic problems. Surgery, radiation the rapy, and cryotherapy are the currently accepted methods for the treat ment of this affliction. To verify the technical and clinical effectiv eness of the surgical laser method, a specific approach was developed by performing laser-combined procedures under microscopic control. Met hods: A series of 26 patients underwent carbon dioxide (CO2) laser mic rosurgical excision of 27 primary superficial BCCs of the eyelid margi ns. Eighteen tumors were T-1 and 9 were T-2. The lesions were located at the lid margins in 18 and at the canthus in 9 cases. The eyelash li ne was involved in all cases, whereas intermarginal space was involved in 17 cases, without extension to the conjunctival border. Six lesion s were in the lacrimal region, Median linear extent of the lesion was 5 mm (range, 4-10 mm). Treatment was performed with the patient under local anesthesia in a Day Hospital regimen. The authors used the micro scope-mounted CO2 laser as a scalpel to excise the tumor mass, thus ob taining the specimen for histologic evaluation. The authors treated th e deep and lateral resection margins with laser vaporization and left the wound bed to heal by secondary intention. Results: No significant complications were observed. As full-thickness eyelid resections were avoided, the authors noted conservation of lid function and cosmetic a spect in all patients. With a median follow-up of 73 months (range, 18 -118), only one patient had tumor recurrence after 22 months. This tum or, located at the outer canthus, had a second microsurgical laser exc ision, and the patient is disease tree 51 months after the last treatm ent. Conclusions: Laser microsurgery appears to be a safe and effectiv e treatment method for primary superficial T1 and T2 BCC of the eyelid margins without conjunctival extension.