Periocular Cutaneous Malignancies: A Review of the Literature

Abstract

Timely diagnosis and management of periocular malignancies is essential because of their proximity to and potential to invade vital structures such as the orbit, sinuses, and brain. Surgical excision remains the standard of care for the majority of periorbital malignancies, but given the sensitive anatomic location, tissue-sparing techniques with margin control such as Mohs micrographic surgery are the preferred method for most nonmelanoma skin cancers. Depending on tumor type, other treatment modalities may include radiation, chemotherapy, cryosurgery, topical medications, and photodynamic therapy.

Orbital exenteration for advanced periorbital non-melanoma skin cancer: prognostic factors and survival

“…5 When orbital invasion of BCC occurs, it has a similarly poor prognosis as other periorbital malignancies, such as SCC. 6 While SCC is a less common periocular malignancy, 20-30% of periocular SCC is multifocal at the time of diagnosis 1,7 with regional involvement in between 1 and 24.3% of cases. 7,8 Perineural invasion occurs in 3-14% of squamous cell carcinomas and is associated with a worse prognosis.…”

“…6 While SCC is a less common periocular malignancy, 20-30% of periocular SCC is multifocal at the time of diagnosis 1,7 with regional involvement in between 1 and 24.3% of cases. 7,8 Perineural invasion occurs in 3-14% of squamous cell carcinomas and is associated with a worse prognosis. 1,8 SGC is a rare, aggressive cancer that not only spreads locally but also demonstrates significant metastatic potential with lymph node involvement present in 30% of cases.…”

Radiotherapy in Periocular Cutaneous Malignancies: A Retrospective Study

“…Besides BCC, the most frequent malignant tumor, SCC, Merkel cell carcinoma, cutaneous melanoma, as well as in situ lesions and rare tumors can occur in this area, accounting for a total of 5–10% of all cutaneous malignancies [1-3]. Not only may periocular tumors behave more aggressively and show higher recurrence rates, but they also represent a challenge for treatment compared to cutaneous lesions at other sites [10, 12, 19]. Previous data show that periocular neoplasms most frequently occur on the lower eyelid and the medial canthus [1, 2, 20-22], which are surgically challenging areas, carrying a risk of functional and aesthetic complications [10, 12, 19].…”

“…Not only may periocular tumors behave more aggressively and show higher recurrence rates, but they also represent a challenge for treatment compared to cutaneous lesions at other sites [10, 12, 19]. Previous data show that periocular neoplasms most frequently occur on the lower eyelid and the medial canthus [1, 2, 20-22], which are surgically challenging areas, carrying a risk of functional and aesthetic complications [10, 12, 19]. Moreover, as observed in our cohort too, periocular tumors tend to develop in fair-skin patients over 60 years of age, who have a history of significant sun exposure [20, 22] – all factors which are known to be associated with the development of skin cancer at any site [23-25], hence concomitant skin cancer is not rare.…”

Cryosurgery during Imiquimod (Immunocryosurgery) for Periocular Basal Cell Carcinomas: An Efficacious Minimally Invasive Treatment Alternative

“…Surgery is currently the suggested treatment for BCC, including tumors of periocular localization [13,14]. However, in order to maximize the preservation of ocular adnexal structures, surgical safety margins for periocular skin tumors tend to be selected as narrowly as possible, resulting in an increased rate of non-R0 pBCC resections and increased relapse hazards [2].…”