Access to intraoperative tumour margin control: a survey of the British Oculoplastic Surgery Society




Periocular malignancy is common and in most cases will undergo excision with pre-determined margins and subsequent histological examination. Intraoperative margin control (IOMC) modalities such as fast frozen section (FFS), fast paraffin (FP) and Mohs micrographic surgery (MMS) are being increasingly widely used, though there is a lack of information regarding utility. The aim of this study was to survey members of the British Oculoplastic Surgery Society (BOPSS) to determine attitudes and access to different modalities of IOMC.


A 12-question online survey was disseminated via an e-mail to full members of the BOPSS. The survey was hosted using Qualtrics software via the University of Sussex.


The overall response rate was 64 of 165 (38.8%). MMS was readily available in a neighbouring trust to 23 of 64 respondents (35.9%). Seven respondents (10.9%) reported no regional access to MMS. Twenty-nine members had readily available access to FFS (45.3%) and 37 of 64 to FP (57.8%) in their own institution. There is variation in what tumour types would be considered appropriate for IOMC, though most thought clinically ill-defined (morphoeic) basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) should undergo one form of IOMC (90.6% and 81.3%, respectively).


This study highlights variation in availability and utilisation of IOMC amongst oculoplastic surgeons and in different regions of the UK. While the exact place of IOMC in periocular tumour excision is debated, there is a consistent view that it should be available for some tumours. Greater consistency in provision may improve patient outcomes.

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  1. 1.

    Saleh GM, Desai P, Collin JR, Ives A, Jones T, Hussain B. Incidence of eyelid basal cell carcinoma in England: 2000-2010. Br J Ophthalmol. 2016;101:209–12.

    Article  Google Scholar 

  2. 2.

    Lear JT, Tan BB, Smith AG, Bowers W, Jones PW, Heagerty AH, et al. Risk factors for basal cell carcinoma in the UK: case-control study in 806 patients. J R Soc Med. 1997;90:371–4.

    CAS  Article  Google Scholar 

  3. 3.

    Margo C, Waltz K. Basal cell carcinoma of the eyelid and periocular skin. Surv Ophthalmol. 1993;38:169–92.

    CAS  Article  Google Scholar 

  4. 4.

    Prabhakaran VC, Gupta A, Huilgol SC, Selva D. Basal cell carcinoma of the eyelid. Compr Ophthalmol Update. 2007;8:1–14.

    PubMed  Google Scholar 

  5. 5.

    Telfer NR, Colver GB, Morton CA. Guidelines for the management of basal cell carcinoma. Br J Dermatol. 2008;159:35–48.

    CAS  Article  Google Scholar 

  6. 6.

    Thissen MR, Neumann MH, Schouten LJ. A systematic review of treatment modalities for primary basal cell carcinomas. Arch Dermatol. 1999;135:1177–83.

    CAS  Article  Google Scholar 

  7. 7.

    Gulleth Y, Goldberg N, Silverman RP, Gastman BR. What is the best surgical margin for a basal cell carcinoma: a meta-analysis of the literature. Plast Reconstr Surg. 2010;126:1222–31.

    CAS  Article  Google Scholar 

  8. 8.

    Trakatelli M, et al. BCC subcomittee of the Guidelines Committee of the European Dermatology Forum. Update of the European guidelines for basal cell carcinoma management. Eur J Dermatol. 2014;24:312–29.

    Article  Google Scholar 

  9. 9.

    Wolf DJ, Zitelli JA. Surgical margins for basal cell carcinoma. Arch Dermatol. 1987;123:340–4.

    CAS  Article  Google Scholar 

  10. 10.

    Hoorens I, Batteauw A, Van Maele G, Lapiere K, Boone B, Ongenae K. Mohs micrographic surgery for basal cell carcinoma: evaluation of the indication criteria and predictive factors for extensive subclinical spread. Br J Dermatol. 2016;174:847–52.

    CAS  Article  Google Scholar 

  11. 11.

    Mohs FE. Micrographic surgery for the microscopically controlled excision of eyelid cancers. Arch Ophthalmol. 1986;104:901–9.

    CAS  Article  Google Scholar 

  12. 12.

    Mosterd K, et al. Surgical excision versus Mohs’ micrographic surgery for primary and recurrent basal-cell carcinoma of the face: a prospective randomised controlled trial with 5-years’ follow-up. Lancet Oncol. 2008;9:1149–56.

    Article  Google Scholar 

  13. 13.

    Rowe DE, Carroll RJ, Day CL Jr. Mohs surgery is the treatment of choice for recurrent (previously treated) basal cell carcinoma. J Dermatol Surg Oncol. 1989;15:424–31.

    CAS  Article  Google Scholar 

  14. 14.

    Narayanan K, Hadid OH and Barnes EA. Mohs micrographic surgery versus surgical excision for periocular basal cell carcinoma. Cochrane Database Syst Rev. 2014:CD007041.

  15. 15.

    Ho S, Brown L, Bamford M, Sampath R, Burns J. 5 years review of periocular basal cell carcinoma and proposed follow-up protocol. Eye. 2013;27:78–83.

    CAS  Article  Google Scholar 

  16. 16.

    Malhotra R, Huilgol SC, Huynh NT, Selva D. The Australian Mohs database: periocular squamous cell carcinoma. Ophthalmology. 2004;111:617–23.

    Article  Google Scholar 

  17. 17.

    Malhotra R, Huilgol SC, Huynh NT, Selva D. The Australian Mohs database, part II: periocular basal cell carcinoma outcome at 5-year follow-up. Ophthalmology. 2004;111:631–6.

    Article  Google Scholar 

  18. 18.

    Conway RM, Themel S, Holbach LM. Surgery for primary basal cell carcinoma including the eyelid margins with intraoperative frozen section control: comparative interventional study with a minimum clinical follow up of 5 years. Br J Ophthalmol. 2004;88:236–8.

    CAS  Article  Google Scholar 

  19. 19.

    Silverman MK, Kopf AW, Gladstein AH, Bart RS, Grin CM, Levenstein MJ. Recurrence rates of treated basal cell carcinomas. Part 4: X-ray therapy. J Dermatol Surg Oncol. 1992;18:549–54.

    CAS  Article  Google Scholar 

  20. 20.

    Mann J, Al-Niami F, Cooper A, Ghura V. A national survey fo Mohs micrographic surgery in the U.K. Br J Dermatol. 2016;174:225–7.

    Article  PubMed  Google Scholar 

  21. 21.

    Essers BA, Dirksen CD, Nieman FH, Smeets NW, Krekels GA, Prins MH, et al. Cost-effectiveness of Mohs micrographic surgery vs surgical excision for basal cell carcinoma of the face. Arch Dermatol. 2006;142:187–94.

  22. 22.

    Telfer NR, Colver GB, Morton CA, British Association of Dermatologists Guidelines for the management of basal cell carcinoma. Br J Dermatol. 2008;159:35–48.

    CAS  Article  PubMed  Google Scholar 

  23. 23.

    Ad Hoc Task Force. et al. AAD/ACMS/ASDSA/ASMS 2012 appropriate use criteria for Mohs micrographic surgery: a report of the American Academy of Dermatology, American College of Mohs Surgery, American Society for Dermatologic Surgery Association, and the American Society for Mohs Surgery. J Am Acad Dermatol. 2012;67:531–50.

    Article  Google Scholar 

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Correspondence to Huw Oliphant.

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Oliphant, H., Oliphant, T., Clarke, L. et al. Access to intraoperative tumour margin control: a survey of the British Oculoplastic Surgery Society. Eye 34, 1679–1684 (2020).

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