Management of Periorbital Basal Cell Carcinoma with Orbital Invasion

Abstract

Basal cell carcinoma (BCC) is the most common eyelid malignancy; however, orbital invasion by periocular BCC is rare, and management remains challenging. Established risk factors for orbital invasion by BCC include male gender, advanced age, medial canthal location, previous recurrences, large tumor size, aggressive histologic subtype and perineural invasion. Management requires a multidisciplinary approach with orbital exenteration remaining the treatment of choice. Globe-sparing treatment may be appropriate in selected patients and radiotherapy and chemotherapy are often used as adjuvant therapies for advanced or inoperable cases, although the evidence remains limited. We aim to summarize the presentation and treatment of BCC with orbital invasion to better guide the management of this complex condition.

Ocular preservation with neoadjuvant vismodegib in patients with locally advanced periocular basal cell carcinoma

“…Eye-sparing surgery has been previously suggested in selected cases 8. Madge et al reported their experience with 20 patients with locally advanced medial canthal BCC with orbital invasion and focused on the desired surgical technique for achieving clear margins while sparing the eye 9.…”

Ocular basal cell carcinoma: a brief literature review of clinical diagnosis and treatment

“…A visible or palpable mass was observed in only 35.7% patients, with no bone fixation and no orbital signs. Other possible symptoms included immobile lids, epiphora (secondary to canalicular or nasolacrimal sac involvement) and ptosis 6,14…”

“…The morpheaform, infiltrating and basosquamous subtypes of BCC are more aggressive but rare (making up only 5%–7% of all cutaneous BCCs), and have a higher rate of residual positive margins after excision, as well as a larger risk of recurrence and metastasis. Consequently, in cases of BCC with orbital invasion, these aggressive subtypes make up >80% of cases 6,14. BCC usually presents as a single lesion with ulceration, or central scarring and peripheral keratosis, with even deep infiltration 3.…”

“…Therefore, paraffin section histology remains the choice of margin control for BCCs with orbital invasion. Reconstruction of the exenterated orbit usually uses split-thickness skin grafts, temporalis muscle flaps or free flaps 12,14. A prospective series of 1,295 patients with periocular BCC managed by MMS using fresh-frozen tissue sections was examined in Australia between 1993 and 1999.…”

Asociación del virus del papiloma humano con enfermedades oculares del segmento anterior y los párpados

“…Más del 20 % de los CBC se produce alrededor de los ojos, de los cuales más de la mitad se presentan en el párpado inferior, un tercio en el canto medial, un 15 % en el párpado superior y un 5 % en el canto lateral (30)(31)(32).…”