Surgical Outcomes and Histopathological Risk Factors in Periocular Basal Cell Carcinoma: A Single-Centre Study of 100 Patients

Objectives: To evaluate the histological subtypes, surgical margin status, and high-risk features of periocular basal cell carcinomas (BCC) excised over a one-year period at a secondary referral centre in England. Materials and Methods: This retrospective audit included 100 consecutive periocular BCC excisions performed at James Paget University Hospital between August 2024 and August 2025. Demographic, clinical, and histopathological data were extracted from operative records and histopathology reports. Surgical margins were classified as complete (≥0.4 mm), close (0.1-0.3 mm), or incomplete (tumour present at the inked margin or <0.1 mm). Fisher's exact test was used to evaluate the association between infiltrative histological subtype and the presence of perineural invasion. Results: Of the 100 patients included (58% male, 42% female; mean age 75.7 years), nodular BCC was the most common histological subtype (83%), followed by infiltrative (14%), superficial (2%), and basosquamous (1%) variants. Complete excision was achieved in 83% of cases, while close and incomplete margins were observed in 8% and 9% of excisions, respectively. Perineural invasion was identified in 2% of tumours, both of which demonstrated infiltrative histology. The infiltrative subtype showed a statistically significant association with perineural invasion (p=0.007). The majority of BCCs were located in the medial canthus (56%), an anatomically complex region associated with increased surgical difficulty and a higher risk of incomplete excision. Conclusion: High rates of complete excision were achieved in this cohort of periocular BCCs. Infiltrative histological subtype was associated with an increased risk of perineural invasion and incomplete excision, particularly when located in the medial canthus. These findings support a risk-adapted surgical strategy as well as consideration of Mohs micrographic surgery for aggressive tumour subtypes and anatomically complex periocular locations.