A review of the management options for periorbital basal cell carcinomas

Abstract

Skin cancer is the most common form of cancer and the incidence of basal cell carcinoma (BCC) is increasing each year ( Cancer Research UK, 2013 ). The incidence of BCC is higher among males, white populations and the older age groups ( Zak-Prelich et al, 2004 ). Anatomically, the head and neck are the most commonly affected sites, attributing to 80% of all reported areas of the body ( Wong et al, 2003 ). According to the British Dermatological Association (BAD) current guidelines ( Telfer, 2008 ), such BCCs are categorised as ‘high risk’ due to their locality and their potential for recurrence. The BAD guidelines propose that the majority of high-risk lesions be treated surgically or by radiotherapy. The eyelids represent a particularly susceptible region for eyelid tumours, and approximately 90% of all eyelid cancers are BCCs ( Baxter et al, 2012 ). Presentation may be diverse; however, it is generally accepted that most BCCs are slow growing, locally invasive, and rarely metastasise, but some variants may be more aggressive. As a form of intervention to remove lesions, surgically there are various options available, namely Mohs micrographic surgery, excision under frozen section control, Slow Mohs and excision with delayed reconstruction. The reconstruction method used by the oculoplastic surgeon will depend on the position and extent of the excised area. This article describes the various treatment options for BCC in more detail, and relates treatment choice to appropriate patient-centred care.