Initial tumor location involving the medial canthus did not increase the statistically significant risk of canalicular injury following Mohs surgery
Clinical Pearls
Basal cell carcinoma was the most common malignancy associated with canalicular injury
Initial tumor location involving the medial canthus did not increase the statistically significant risk of canalicular injury following Mohs surgery
History of facial radiation, immunocompromised status, history of eyelid procedures, and pre/postoperative size did not reliably predict canalicular injury
Discussion:
There is a paucity of data regarding canalicular injury following periocular Mohs surgery. This complication, which is found in 5.3-10% of patients undergoing Mohs micrographic surgery (MMS) for periocular tumors, carries significant morbidity, including permanent epiphora. This case control study sought to identify risk factors for canalicular injury that may inform the operating surgeon and patient effectively. It included twenty-two cases of patients with periocular tumors requiring Mohs micrographic surgery who developed canalicular injury as well as sixty-two matched controls who required non-canalicular oculoplastic repair following MMS.
Basal cell carcinomas were found to in 86.4% of cases (P <0.00001). Among basal cell carcinoma subtypes, infiltrative, morpheaform and/or micronodular type were more frequent among cases vs. controls (P = 0.0478). Interestingly, preoperative location of the periocular tumor on the medial canthus was not found to be statistically associated with increased frequency of canalicular injury. This is perhaps due to the anatomical barrier that is created by the medial canthi’s postseptal location, as compared to the more superficial and thus higher risk location inferior and superior canaliculi. Furthermore, history of facial radiation, immunocompromised status, history of eyelid procedures and pre/postoperative size were not found to reliably predict canalicular injury.
While this case control study offers insight into possible epidemiological factors surrounding canalicular injury following periocular MMS, its small sample size and power increase risk of selection bias and type II error. Further elucidation with larger sample sizes and prospective format would allow for better identification of epidemiologic risk factors and improved treatment strategy to decrease canalicular injury among patients with periocular tumors requiring MMS.
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