Palliative Radiotherapy to Preserve Eyesight in a Recurrent, Difficult-to-Treat Basal Cell Carcinoma

This case discusses an 85-year-old patient with a history of cataract causing severe right eye vision impairment and repeated surgeries for a basal cell carcinoma (BCC) on the right temple and its local recurrences (wide local excision in 2010; re-excision and reconstruction with a skin graft in 2017), who presented with progressive growth and extension of the skin tumour. Upon examination, an irregular, erythematous plaque with multiple ulcerations on the surface (the largest measuring 4 × 3 cm on the left temple) was observed. The lesion extended from one temple to the other, over the forehead, along the margins of the surgical skin graft, and invaded the upper left eyelid, with a protruding mass extending out of the orbit. A punch skin biopsy of the largest ulceration revealed basal cell carcinoma, infiltrative subtype, with areas of bone invasion. Given the difficult clinical scenario, the complex anatomical location, and the potential morbidity associated with surgery, the patient was deemed suitable for radiotherapy after a thorough evaluation. The patient showed good tolerance to treatment, with mild radiodermatitis managed topically, and achieved a satisfactory therapeutic response. Clinical and radiological evaluations demonstrated substantial regression in lesion size, no significant toxicities, and preservation of vision in the left eye. This case highlights the successful use of palliative radiotherapy in a patient with recurrent giant basal cell carcinoma of the upper face with orbital invasion, achieving eyesight preservation when surgery or systemic therapy were not viable options. Radiotherapy is emerging as a valuable treatment option for recurrent basal cell carcinoma in challenging anatomical locations. However, careful monitoring and rigorous treatment planning are essential forachieving favourable outcomes while minimizing side effects.