Orbital exenteration and reconstruction for massive basal cell and squamous cell carcinoma of cutaneous origin

Eleven patients with basal cell or squamous cell carcinomas of skin origin requiring orbital exenteration over a ten-year period were reviewed. The patient population was characterized by old age, treatment delay, massive tumor size, and inadequate primary therapy. Following orbital exenteration, a 60% recurrence rate and 56% five-year survival were found. Combined craniofacial resection should be considered more frequently in hopes of improving prognosis. Split-thickness skin grafting was the mainstay of reconstruction, especially in elderly patients with smaller lesions. However, most of the operations were performed prior to the popularization of musculocutaneous flaps and free tissue transfers. Temporalis, forehead, and cheek flaps are dependable local alternatives when additional bulk or improved contour is desired. Latissimus dorsi and pectoralis major musculocutaneous flaps and microsurgical tissue transfer allow for coverage of defects of virtually unlimited size and may be superior in cases in which infectious or postradiation complications are anticipated.