What is the recurrence rate of Basal Cell Carcinoma (BCC) after surgical excision in the eyelid?

From the Guidelines

Basal cell carcinomas (BCCs) on the eyelid can potentially recur after surgery, typically within the first 1-3 years following the procedure, with a recurrence rate of 1.0% for primary BCC and 5.6% for recurrent BCC when treated with Mohs micrographic surgery 1. The recurrence timeline varies based on several factors including the surgical technique used, tumor characteristics, and margin clearance.

• Mohs micrographic surgery has the lowest recurrence rates (1-3%), providing better outcomes than standard excision (5-10% recurrence) 1.
• Incompletely removed BCCs may recur more quickly, sometimes within months, while even properly excised tumors can occasionally return years later.
• Aggressive BCC subtypes (morpheaform, infiltrative) tend to recur faster and more frequently than nodular types.
• Post-surgery follow-up examinations are crucial, typically scheduled every 3-6 months for the first two years, then annually thereafter.
• Patients should monitor for any new lesions, changes in skin appearance, or unusual sensations at the surgical site, as early detection of recurrence allows for prompt intervention. The eyelid's thin, delicate tissue and proximity to vital structures make complete tumor removal challenging, which contributes to the recurrence risk in this specific location. It is essential to note that a large proportion of recurrences occurred more than 5 years after treatment, emphasizing the importance of long-term follow-up in therapeutic trials evaluating treatment modalities for BCC, as well as the need for long-term follow-up of patients with high-risk tumors 1. In terms of treatment options, Mohs micrographic surgery is the preferred surgical technique for high-risk BCC, allowing intraoperative analysis of 100% of the excision margin 1. While radiation therapy may be considered in certain cases, it is often reserved for patients older than 60 years due to concerns about long-term sequelae, and its efficacy is better for BCCs that are less advanced, primary, and have smaller diameter or nodular histologic subtype 1.

From the Research

Recurrence of Basal Cell Carcinoma (BCC) After Surgery

• The recurrence of BCC after surgical excision can occur, with a mean recurrence time of 31.2 months 2, 3.
• The majority of recurrences occur within 3 years after the primary treatment 2.
• The topographic localization of tumors that recurred included various sites, with one case of recurrence on the lower eyelid 2.
• Histologically, 50% of primary and 54.8% of recurrent BCCs demonstrated at least partial aggressive-growth features 2.
• The study by 3 found that all recurrent excised lesions were of free margin less than 4 mm, suggesting that even with clear margins, recurrence can still occur.
• Predictive factors for recurrence include a Breslow index >2, Clark level >3, and excision margins both lateral and deep free from tumoral cells ≤1 mm 4.
• The expression levels of certain proteins, such as GLI1, YAP, and E-cadherin, were not different in recurrent vs. non-recurrent BCCs, but low expression of CTGF may indicate a tumor with higher aggressiveness 4.
• The maximum recurrence rate expressed as a percentage of index lesions was 1.3% (20/1516) in a study with a minimum 5-year follow-up period 5.

Specifics on Eyelid Recurrence

• There is limited information available on the recurrence of BCC specifically on the eyelid after surgery.
• One study reported a single case of recurrence on the lower eyelid 2, but no specific details on the time to recurrence or other factors related to this case were provided.
• Further research is needed to determine the rate and characteristics of BCC recurrence on the eyelid after surgical excision.