Micrographically controlled excision (Mohs' surgery) of basal cell carcinoma around the eye. Combined dermatological surgical clearance and oculoplastic surgical repair.

Periorbital infiltrative basal cell carcinomas are notoriously difficult to treat, particularly those around the medial canthus. Micrographically controlled excision with horizontal frozen sections (Mohs' surgery) allows for clearance of the tumour with minimal loss of normal tissue. Once the tumour has been completely removed, the defect can be repaired by the oculoplastic surgeon for the best functional and cosmetic result. This is the ideal treatment for tumours with a contiguous growth pattern that are liable to be seriously over or under treated by other modalities. The technique requires special training for both the operator and the Medical Laboratory Scientific Officer (MLSO). It is costly in time and manpower but in selected cases, where recurrent tumour is most dangerous and where tissue conservation is paramount, it may be invaluable. Close collaboration between dermatological and oculoplastic surgeons in such cases probably offers the patient the best treatment and outcome.