Globe-sparing surgery for medial canthal Basal cell carcinoma with anterior orbital invasion

Ophthalmology. 2010 Nov;117(11):2222-8. doi: 10.1016/j.ophtha.2010.02.013. Epub 2010 Jun 8.


Purpose: To describe a case series of patients with anterior orbital invasion by medial canthal basal cell carcinoma (BCC) managed with non-exenterating surgery.

Design: International, multicenter, retrospective, noncomparative, consecutive case series.

Participants: Twenty patients identified from the individual institutions' databases with histologically confirmed orbital invasion by periocular BCC.

Methods: Examination of charts, relevant imaging, and histopathologic data.

Main outcome measures: Demographics; clinical characteristics and radiologic features; histopathologic features; surgical techniques for excision, reconstruction, and subsequent procedures; complications; visual acuity; and recurrence.

Results: Twenty patients were identified. Twelve of 20 patients (60%) had recurrent BCCs, with 1 patient having had prior radiotherapy for previously incomplete excision. Eighteen of 20 patients (90%) had a palpable mass, 16 of 20 patients (80%) had clinical involvement of the nasolacrimal system, and 1 of 20 patients (5%) had limited extraocular movements. Preoperative radiologic evidence of orbital invasion was found in 10 of 20 patients (50%). Histologic evidence of orbital invasion was present in every patient, the subtypes being infiltrative (9/20, 45%), nodular (4/20, 20%), micronodular (2/20, 10%), multifocal (1/20, 5%), and mixed (4/20, 20%); extratumoral perineural invasion was present in 1 patient (5%). Final margins were clear in 18 of 20 patients (90%), positive in 1 of 20 patients (5%), and unclear in 1 of 20 patients (5%). Reconstruction was by direct closure in 1 patient and by a variety of standard oculoplastic flaps and grafts in 19 of 20 patients (95%). Twelve of 20 patients (60%) had postoperative extraocular muscle movement restriction, and 15 of 20 patients (75%) had epiphora. Subsequent revision procedures were needed in 12 of 20 patients (60%), including insertion of a lacrimal bypass tube and revision of medial canthal position. At a mean follow-up of 38 months, 18 of 20 patients (90%) were still alive (2 deaths due to other causes) with 1 recurrence (exenterated). Postoperative visual acuity was within 2 Snellen lines of preoperative visual acuity in 17 of 20 patients (85%).

Conclusions: With careful planning and margin control, conservative surgery in this highly selected group proved possible with a low rate of disease recurrence, albeit with a relatively short follow-up. Postoperative complications, such as epiphora and ophthalmoplegia, were largely expected; most patients underwent subsequent revision procedures to address these and other complications.

Financial disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Carcinoma, Basal Cell / diagnostic imaging
  • Carcinoma, Basal Cell / secondary
  • Carcinoma, Basal Cell / surgery*
  • Eyelid Neoplasms / diagnostic imaging
  • Eyelid Neoplasms / pathology
  • Eyelid Neoplasms / surgery*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Neoplasm Invasiveness
  • Neoplasm Recurrence, Local*
  • Ophthalmologic Surgical Procedures*
  • Orbit / surgery*
  • Orbital Neoplasms / diagnostic imaging
  • Orbital Neoplasms / secondary
  • Orbital Neoplasms / surgery*
  • Postoperative Complications
  • Retrospective Studies
  • Skin Neoplasms / diagnostic imaging
  • Skin Neoplasms / pathology
  • Skin Neoplasms / surgery*
  • Tomography, X-Ray Computed
  • Treatment Outcome