Algorithm for intra-operative margin control techniques in the management of periocular Bowen’s disease

Yi (Lucy) Yang, Dnyaneshwar D. Athavale, Andrew Gal, Brett A O'Donnell

Meeting:  2022 RANZCO


Date:      -

Session Title: FREE PAPERS – Oculoplastic/Ocular Oncology

Session Time:      -

Purpose: To discuss the choice of margin control techniques for periocular Bowen’s disease, including the ‘Calamari Ring’ method of intra-operative margin control.

Methods: A retrospective study was conducted on patients records of a single surgeon from 1996 to 2020. Cases of periocular Bowen’s disease were identified, with methods of margin control including the ‘Calamari Ring’ method, Mohs micrographic surgery, ‘en face’ frozen sec- tion and overnight paraffin. Main outcome measured the rate of recurrence of periocular Bowen’s disease.

Results: A total of 91 cases of Bowen’s disease were included in this study. The lesions were found more often on the right side (54%), at the central lower lid region (48%), with a mean diameter of 9.99 mm (range 2.5-50). Seventy-four cases (81%) were primary lesions and the remainder recurrent or residual. The margin control techniques included ‘Calamari ring’ (46%), Mohs micro- graphic surgery (29%), ‘en face’ frozen section (5%), over- night paraffin (4%) and no intra-operative margin control (15%). The median follow up was 18 months (range 0-200). There was recorded recurrence in three cases (3%) overall. In the subset of ‘Calamari ring’ method, there was one case of recurrence out of 42 total cases (2%).

Conclusions: The method of choice for margin control needs to be considered based on the location, size and characteristics of the lesion. The ‘Calamari Ring’ method of managing periocular Bowen’s disease demonstrated low recurrence rates comparable to Mohs micrographic surgery and ‘en face’ frozen section.