To compare the results of one-step surgery (OSS) and two-step surgery (TSS) in the surgical management of eyelid basal cell carcinomas (BCC).

A total of 43 eyes of 43 patients were included. OSS was applied to 22 of these patients, while TSS was applied to 21 patients. The safety margin width (SMW), the size and location of the tumor, the histopathology results, and the reconstructive procedures were compared.

Resected tumor sizes were significantly larger in the TSS group than in the OSS group (largest tumor diameter: p = 0.005 and perpendicular diameter to largest diameter: p = 0.01). Excised SMW was higher in the OSS group compared to the TSS group (p = 0.008). A positive histopathological margin was observed in 2 patients (9%) in the TSS group and in 5 patients (22%) in the OSS group (p = 0.241). In addition, excision status including the nasolacrimal drainage system (NLDS) components was present in 4 patients (18%) in OSS group and 6 patients (28%) in TSS group (p = 0.42). While monocanalicular tube intubation could be performed in all TSS patients, it could only be performed in 1 patient in the OSS group (p = 0.03). The total number of reconstructive procedures performed was similar between groups (p = 0.058).

With regard to recurrence and metastasis, both OSS and TSS demonstrated success in the present study. This success was achieved in larger eyelid BCC tumors using the TSS technique with smaller amounts of SMW and in smaller eyelid BCC tumors using the OSS technique with larger amounts of SMW.