Periorbital basal cell carcinoma requiring ablative craniofacial surgery

Area of Science:

• Ophthalmology
• Oncology
• Plastic Surgery

Background:

• Recurrent periorbital basal cell carcinoma (BCC) poses significant treatment challenges.
• Tumors often present with medial canthal and eyelid involvement, history of multiple surgeries, and morphealike appearance.
• Histologic findings include dense hyaline fibrosis and perineural invasion, indicating aggressive tumor behavior.

Purpose of the Study:

• To present cases of advanced periorbital BCC requiring extensive craniofacial resection.
• To highlight the clinical and histologic features associated with such aggressive tumors.
• To emphasize the importance of early surgical intervention in managing periorbital BCC.

Main Methods:

• Case series presentation of four patients with recurrent periorbital BCC.
• Detailed description of clinical presentation, tumor characteristics, and surgical procedures.
• Surgical approach involved craniofacial composite orbitectomies with intracranial access and flap coverage.

Main Results:

• All four patients required extensive composite resection including orbit, ethmoidal sinus, orbital contents, and surrounding soft tissues.
• An intracranial approach via frontal craniotomy was necessary for resection and reconstruction.
• Distant flap coverage was utilized to manage the resultant large defects.

Conclusions:

• Aggressive, early, and complete surgical resection is crucial for managing periorbital BCC.
• Timely intervention can prevent the need for extensive, mutilating craniofacial surgeries.
• Avoiding orbital invasion through prompt treatment is key to better patient outcomes.