Malignant eyelid tumors: Are intra-operative rapid frozen section and permanent section diagnoses of surgical margins concordant?

Abstract

Purpose

To study the concordance between intra-operative rapid frozen section and permanent section diagnoses of surgical margins following wide surgical excisional biopsy of malignant eyelid tumors.

Methods

This is a retrospective study of 120 cases and 429 frozen section slides.

Results

Of 120 cases, 75 (63%) had sebaceous gland carcinoma, 34 (28%) had basal cell carcinoma, and 11 (9%) had squamous cell carcinoma. All cases with these malignant eyelid tumors underwent wide surgical excisional biopsy under frozen section control of surgical margins. A total of 429 frozen section slides were reviewed for rapid frozen section diagnosis. Eyelid reconstruction was performed in all cases after clearance was obtained by rapid frozen section diagnosis of surgical margins as negative for tumor infiltration. Permanent section diagnosis of surgical margins was positive for tumor infiltration in 5 (1%) slides, which were reported as negative on rapid frozen section diagnosis of surgical margins, and was negative for tumor infiltration in 3 (< 1%), which were reported as positive on initial rapid frozen section diagnosis of surgical margins. The sensitivity, specificity, and accuracy of intra-operative rapid frozen section diagnosis of surgical margins for malignant eyelid tumors were 89%, 99%, and 98%, respectively.

Conclusion

The concordance between the intra-operative rapid frozen section and permanent section diagnoses of surgical margins following wide surgical excisional biopsy of malignant eyelid tumors is excellent at 98%.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2

References

  1. 1.

    Jacyna LS (1988) The laboratory and the clinic: the impact of pathology on surgical diagnosis in the Glasgow Western Infirmary, 1875–1910. Bull Hist Med 62:384–406

    CAS  PubMed  Google Scholar 

  2. 2.

    Wright JR Jr (1985) The development of the frozen section technique, the evolution of surgical biopsy, and the origins of surgical pathology. Bull Hist Med 59:295–326

    PubMed  Google Scholar 

  3. 3.

    Fechner RE (1977) The birth and evolution of American surgical pathology. In: Rosai J (ed) Guiding the surgeon’s hand. American Registry of Pathology, Armed Forces Institute of Pathology, Washington DC

    Google Scholar 

  4. 4.

    Gal AA (2005) The centennial anniversary of the frozen section technique at the Mayo Clinic. Arch Pathol Lab Med 129:1532–1535

    PubMed  Google Scholar 

  5. 5.

    Lechago J (2005) The frozen section: pathology in the trenches. Arch Pathol Lab Med 129:1529–1531

    PubMed  Google Scholar 

  6. 6.

    Chévez-Barrios P (2005) Frozen section diagnosis and indications in ophthalmic pathology. Arch Pathol Lab Med 129:1626–1634

    PubMed  Google Scholar 

  7. 7.

    Ferreiro JA, Myers JL, Bostwick DG (1995) Accuracy of frozen section diagnosis in surgical pathology: review of a 1-year experience with 24,880 cases at Mayo Clinic Rochester. Mayo Clin Proc 70:1137–1141

    CAS  Article  Google Scholar 

  8. 8.

    Mahe E, Ara S, Bishara M et al (2013) Intraoperative pathology consultation: error, cause and impact. Can J Surg 56:E13–E18

    Article  Google Scholar 

  9. 9.

    Older JJ, Quickert MH, Beard C (1975) Surgical removal of basal cell carcinoma of the eyelids utilizing frozen section control. Trans Am Acad Ophthalmol Otolaryngol 79:658–663

    CAS  Google Scholar 

  10. 10.

    Downes RN, Walker NPJ, Collin JRO (1990) Micrographic (Mohs’) surgery in the management of periocular basal cell epitheliomas. Eye 4:160–168

    Article  Google Scholar 

  11. 11.

    Wong VA, Marshall JA, Whitehead KJ et al (2002) Management of periocular basal cell carcinoma with modified en face frozen section controlled excision. Ophthal Plast Reconstr Surg 18:430–435

    Article  Google Scholar 

  12. 12.

    Hamada S, Kersey T, Thaller VT (2005) Eyelid basal cell carcinoma: non-Mohs excision, repair, and outcome. Br J Ophthalmol 89:992–994

    CAS  Article  Google Scholar 

  13. 13.

    Mohs FE (1986) Micrographic surgery for the microscopically controlled excision of eyelid cancer: history and development. Adv Ophthal Plast Reconstr Surg 5:381–408

    CAS  Google Scholar 

  14. 14.

    Mohs FE (1986) Micrographic surgery for the microscopically controlled excision of eyelid cancers. Arch Ophthalmol 104:901–909

    CAS  Article  Google Scholar 

  15. 15.

    Robins P, Rodriguez-Sains R, Rabinovitz H et al (1985) Mohs surgery for periocular basal cell carcinomas. J Dermatol Surg Oncol 11:1203–1207

    CAS  Article  Google Scholar 

  16. 16.

    Monheit GD, Callahan MA, Callahan A (1989) Mohs micrographic surgery for periorbital skin cancer. Dermatol Clin 7:677–697

    CAS  Article  Google Scholar 

  17. 17.

    Pieh S, Kuchar A, Novak P et al (1999) Long term results after surgical basal cell carcinoma excision in the eyelid region. Br J Ophthalmol 83:85–88

    CAS  Article  Google Scholar 

  18. 18.

    Leib ML, Johanson DA, Eliezri YD (1992) Mohs histographic surgery and ophthalmic plastic reconstruction. Ophthal Plast Reconstr Surg 8:262–270

    CAS  Article  Google Scholar 

  19. 19.

    Glatt HJ, Olson JJ, Putterman AM (1992) Conventional frozen sections in periocular basal-cell carcinoma: a review of 236 cases. Ophthalmic Surg 23:6–8

    CAS  PubMed  Google Scholar 

  20. 20.

    Frank HJ (1989) Frozen section control of excision of eyelid basal cell carcinomas: 81/2 years’ experience. Br J Ophthalmol 73:328–332

    CAS  Article  Google Scholar 

  21. 21.

    Chalfin J, Putterman AM (1979) Frozen section control in the surgery of basal cell carcinoma of the eyelid. Am J Ophthalmol 87:802–809

    CAS  Article  Google Scholar 

  22. 22.

    Ratz JL, Luu-Duong S, Kulwin DR (1986) Sebaceous carcinoma of the eyelid treated with Mohs’ surgery. J Am Acad Dermatol 14:668–673

    CAS  Article  Google Scholar 

  23. 23.

    Spencer JM, Nossa R, Tse DT, Sequeira M (2001) Sebaceous carcinoma of the eyelid treated with Mohs micrographic surgery. J Am Acad Dermatol 44:1004–1009

    CAS  Article  Google Scholar 

  24. 24.

    Snow SN, Larson PO, Lucarelli MJ et al (2002) Sebaceous carcinoma of the eyelids treated by mohs micrographic surgery: report of nine cases with review of the literature. Dermatol Surg 28:623–631

    PubMed  Google Scholar 

  25. 25.

    Brady KL, Hurst EA (2017) Sebaceous carcinoma treated with Mohs micrographic surgery. Dermatol Surg 43:281–286

    CAS  Article  Google Scholar 

  26. 26.

    Callahan EF, Appert DL, Roenigk RK, Bartley GB (2004) Sebaceous carcinoma of the eyelid: a review of 14 cases. Dermatol Surg 30:1164–1168

    PubMed  Google Scholar 

  27. 27.

    Nemet AY, Deckel Y, Martin PA et al (2006) Management of periocular basal and squamous cell carcinoma: a series of 45 cases. Am J Ophthalmol 142:293–297

    Article  Google Scholar 

  28. 28.

    Gayre GS, Hybarger CP, Mannor G et al (2009) Outcomes of excision of 1750 eyelid and periocular skin basal cell and squamous cell carcinomas by modified en face frozen section margin-controlled technique. Int Ophthalmol Clin 49:97–110

    Article  Google Scholar 

  29. 29.

    Donaldson MJ, Sullivan TJ, Whitehead KJ et al (2002) Squamous cell carcinoma of the eyelids. Br J Ophthalmol 86:1161–1165

    CAS  Article  Google Scholar 

Download references

Funding

The authors would like to acknowledge the support provided by The Operation Eyesight Universal Institute for Eye Cancer and Hyderabad Eye Research Foundation, Hyderabad, India.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Swathi Kaliki.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Research involving human participants and/or animals

This article does not contain any studies with animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Kaliki, S., Pyda, S., Goel, N. et al. Malignant eyelid tumors: Are intra-operative rapid frozen section and permanent section diagnoses of surgical margins concordant?. Int Ophthalmol 39, 2205–2211 (2019). https://doi.org/10.1007/s10792-018-1058-0

Download citation

Keywords

  • Eye
  • Eyelid
  • Tumor
  • Frozen section
  • Permanent section
  • Histopathology
  • Sebaceous gland carcinoma
  • Basal cell carcinoma
  • Squamous cell carcinoma