Quelles marges d'exérèse pour les carcinomes de paupières ?

Traditional surgical treatment of non-melanoma skin cancer includes excision with adjacent surgical margins, such “safety” margins theoretically leading to lower recurrence rates. Thus, some authors favor a clinical excision margin of 4 mm for basal cell carcinoma and 6 mm for squamous cell carcinoma. However, such “safety” margins cannot be applied in all cases of eyelids tumors for anatomic and functional reasons, because such recommendations may lead to severe ocular complications, even loss of the globe. Thus, in order to mitigate these issues in oculoplastic surgery, excision with reduced margins is proposed, either with frozen sections or with traditional pathologic analysis and secondary reconstructive surgery several days later. The purpose of this article is to demonstrate that it is possible to reduce surgical margins while respecting “safety” from tumor recurrence, in order to preserve ocular integrity. The most appealing technique is frozen section of the margins, corresponding to “slow-Mohs” micrographic surgery.