REPLY: Risk Factors for Orbital Exenteration in Periocular Basal Cell Carcinoma

We reported 1 that we were not able to achieve negative tumor margins on half of the patients who underwent exenteration because in those 12 patients tumor infiltration had already reached the bone. In fact, as mentioned in the text, the CT scan had already reported evidence of bone invasion in 8 patients. We consider clear margin only those cases having evidence of negative margin on soft tissues of the exenterated orbit, since the evaluation of clear margin on bone is doubtful, particularly if the medial bone and the lacrimal bone and the nasolacrimal duct are involved because the removal of the bone structure to obtain negative margin in radical manner could be life threatening considering the adjacent structures as the frontal lobe. Sixteen of our exenterated patients had medial canthus and lower eyelid involvement. Eventually, we did not perform routinely frozen section for exenteration procedure since the goal of this operation is always to remove the whole orbital content. We use frozen section intraoperative margin control when we deal with a lesion of the superficial periorbital region for which an orbital invasion is suspeced. Infact this technique does not allow intraoperative control of the bone. As mentioned in the text, in these twelve patients were offered an additional therapy, accepted by 7 and consisting in local radiation therapy. Moreover, 4 patients because of relapse had further surgical excision and other 4 additional radiotherapy. We are conscious that often the interpretation of data from a retrospective research may have some limitations. Nevertheless, we would like to emphasize that the main objective of this study is to evaluate the percentage of patients with basal cell carcinoma who need exenteration and which are possible risk factors.