Clinical characteristics and prognostic factors associated with recurrence in periocular basal cell carcinoma in a Taiwanese population.

Abstract

Purpose: Basal cell carcinoma (BCC) is the most common malignancy of the eyelid, with a significant risk of local recurrence despite its low metastatic potential. Understanding prognostic factors for recurrence is essential for optimizing treatment and improving patient outcomes. This study aimed to analyze the clinical characteristics and prognostic factors associated with recurrence in periocular BCC in a Taiwanese population.

Study design: This was a retrospective, single-center cohort study conducted at a tertiary medical center in Taiwan.

Methods: We reviewed 46 patients diagnosed with periocular BCC at National Taiwan University Hospital between 2000 and 2023. Data on demographics, tumor characteristics, surgical margins, and recurrence outcomes (both clinical and pathological) were collected. Recurrence-free survival was assessed using Kaplan-Meier analysis, and statistical analyses, including chi-square tests, Fisher's exact tests, and multivariate logistic regression, were performed to identify significant prognostic factors.

Results: The mean age at diagnosis was 72.3 years, with a slight female predominance (54.4%). Tumors predominantly affected the lower eyelid (84.8%). The study identified a clinical recurrence rate of 30.4% with a 10-year recurrence-free survival (RFS) of 67.4%. Upon strict histological confirmation, the pathological recurrence rate was 23.9%, corresponding to an RFS of 73.7%. Multivariate analysis identified two robust independent predictors across both definitions. Compromised surgical margins were strongly associated with recurrence (Clinical: OR = 5.70, p < 0.001; Pathological: OR = 15.56, p < 0.05). Similarly, delayed surgical intervention (>12 months) significantly increased recurrence risk (Clinical: OR = 5.21, p = 0.001; Pathological: OR = 14.21, p < 0.05). Tumor size and thickness were correlated with recurrence in univariate analysis but did not reach statistical significance in the multivariate models.

Conclusion: Compromised surgical margins and delayed treatment are robust, major risk factors for recurrence in periocular BCC, regardless of whether a clinical or pathological definition is applied. While the clinical recurrence rate highlights the burden of re-operation, the pathological recurrence rate underscores the biological aggressiveness in neglected cases. Notably, achieving free margins resulted in excellent long-term control. These findings emphasize the critical need for early diagnosis and complete excision to improve patient outcomes.