Oculoplastics

36 3 Eyelid Neoplasms

BASAL CELL CARCINOMA B asal cell carcinoma is the most common type of skin cancer. It is locally invasive and aggressive but has very limited capacity to metastasize. If neglected, it can invade the or bit, especially if located in the medial canthal area. Most commonly, it occurs on the lower eyelid and is treated by complete surgical excision. Epidemiology and Etiology ● Age: More than 40 years. Rare cases do oc cur in the 20s and 30s. ● Gender: Males more than females ● Etiology: Sun exposure and fair skin with poor ability to tan are risk factors. Treatment with x-ray (for acne) increases the risk. ● Incidence: 500 to 1000 per 100,000 people History ● Slowly enlarging lesions in sun-exposed areas ● The lesions may be associated with bleeding. Examination ● Round or oval, firm lesions with depressed center ● The lesions are pink or red with fine thread-like telangiectasia. ● The center may be ulcerated. Basal cell car cinoma may also appear scar-like or can rarely be cystic ( Fig. 3-4A–D ). Special Considerations ● Aggressive treatment of basal cell carci noma of the medial canthal area is indicated because of the risk of orbital extension from the medial canthal area.

● Basal cell carcinomas almost never metastasize. ● Sclerosing basal cell carcinomas have poorly defined margins and may recur. ● Basal cell nevus syndrome is an autosomal dominant syndrome in which patients de velop multiple basal cells at a very young age ( Fig. 3-4E and F ). Differential Diagnosis ● Squamous cell carcinoma ● Trichoepithelioma Laboratory Tests ● Lesions are sent for pathologic evaluation. Treatment ● Complete surgical excision with pathologic evaluation ● Frozen sections or Mohs surgery is needed to ensure complete excision. ● Reconstruction of the defect is then com pleted at the same time. ● Treatment with radiation should not be used for lesions around the eye unless the pa tient is not a surgical candidate. ● Imiquimod cream can be used as a nonsur gical option if the lesion is not close to the eyelid margin. Prognosis ● Good when promptly and completely excised ● Neglected cases can invade the orbit and brain and have the potential, in rare cases, to be fatal.

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