A Rare Case of Morpheaform Basal Cell Carcinoma With Lacrimal Sac Invasion

Basal cell carcinoma (BCC) is the most common type of skin cancer and is a significant focus in plastic surgery practice. BCC also represents the most common epithelial tumor of the periocular region, particularly affecting the medial canthus and lower eyelid. Multiple studies have suggested that tumor recurrence is more likely when BCC arises in specific anatomical sites, such as the medial canthus, or involves aggressive histological subtypes like morpheaform or sclerosing variants. BCC located near the medial canthus may extend to involve the lacrimal drainage system and adjacent ocular structures if not treated promptly. Nevertheless, direct invasion of the lacrimal canaliculus or sac remains uncommon, with only a few cases reported in the literature to date. In this report, we present a case of morpheaform BCC with invasion of the lacrimal sac and discuss the surgical management and reconstructive approach.