Clinico-Pathological Conference (CPC) Meet

Karpagam Medical College Hospital27-02-2015

Basal Cell Carcinoma (BCC) – Eyelid

with Orbital Exenteration

BCC Eyelids

• Mrs. X 80/F• Ulcer over left upper eyelid 8 months• Loss of vision in left eye – 4 months• Past H/O surgery for BCC 2 years back - excision O/E – No nodes

Dx- Recurrent BCC Lt Upper Eyelid

Pre operative skin preparation and marking for incision

Circum-orbital incision to expose the orbital pad of fat

Dissection of eyeball sparing the periosteum and ligating all vessels

Exenteration done with osteotomy of lateral orbital wall due to suspicion of infiltration laterally

Post operative specimen – Anterior view

Post operative specimen – Medial view

Immediate postoperative period

Post operative Day 3

Post operative Day 7

MALIGNANT EYELID TUMOURS

1. Basal cell carcinoma

2. Squamous cell carcinoma

3. Meibomian gland carcinoma

4. Melanoma

5. Kaposi sarcoma

6. Merkel cell carcinoma

7. Treatment

Basal Cell Carcinoma - Important Facts

1. Most common human malignancy

2. Usually affects the elderly

3. Slow-growing, locally invasive

5. 90% occur on head and neck

6. Of these 10% involve eyelids

7. Accounts for 90% of eyelid malignancies

4. Does not metastasize

Frequency of location of basal cell carcinoma

Lower lid - 70% Medial canthus - 15%

Upper lid - 10% Lateral canthus - 5%

Nodular basal cell carcinomaEarly

• Shiny, indurated nodule• Surface vascularization

• Slow progression

Advanced

• May destroy large portion of eyelid

Ulcerative basal cell carcinoma(rodent ulcer)

Early

Chronic ulceration

Advanced

Raised rolled edges and bleeding

Sclerosing basal cell carcinoma

• Indurated plaque with loss of lashes

Advanced

• Spreads radially beneath normal epidermis

Early

• May mimic chronic blepharitis • Margins impossible to delineate

Histology of basal cell carcinoma

Downgrowth from epidermisof small, dark atypical basal cells

Peripheral palisading

Cell nests in fibrous stroma

Treatment Options

3. Cryotherapy

2. Radiotherapy• Small BCC not involving medial canthus

1. Surgical excision• Method of choice

• Small and superficial BCC irrespective of location

• Adjunct to surgery in selected cases

Lower eyelid reconstruction following tumour excision

Mustarde cheek rotation flap for large defect

Tenzel flap for moderate defect

Direct closure of small defect

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