Basal Cell Carcinoma of Eyelid

-Constitutes 85-90% of all malignant eyelid epithelial tumours.

MECHANISM:
-Arises from a pluripotent stem cell in the epidermis that proliferates, amplifies and terminally differentiates
-Enhanced tumour cell motility and collagenase content

LOCATION:
-50-60% affect lower eyelid
Medial canthus: 25-30%
Upper lid 15%
Lateral canthus 5%

TYPES:
1) Nodular-ulcerative:
-Most common
-Pink/pearly papule or nodule with overlying telangiectatic vessels
-Central ulceration with rolled border.
-Called rodent ulcer

2) Pigmented
-Similar to nodular-ulcerative in morphology but with brown/black pigmentation
-Resemble malignant melanoma.

3) Morphea or Sclerosing

-Flat, indurated, yellow-pink plaque with ill-defined borders
-May stimulate blepharitis or dermatitis
-Aggressive
-Invades dermis deeply
-Occurs in medial canthal region
-May invade into PNS and orbit.

4) Superficial
-Erythematous, scaling patch with raised pearly border
-Arise on the trunk.

5) Fibroepithelioma
-Pedunculated or sessile, smooth, pink nodule
-Arise on the trunk.

SYSTEMIC ASSOCIATIONS:
-Basal cell nevus syndrome (Gorlin-Gotz syndrome)
-Palmar and plantar pits
-Bazex syndrome
-Linear unilateral basal cell nevus
-Rombo syndrome
-Albinism.
-Xeroderma pigmentosa.
-Nevus sebaceus.

TREATMENT:
-Moh's Micrographic Surgery
-Excisional biopsy with frozen section control
-Radiation therapy (CI in basal cell nevus syndrome)
-Cryotherapy (outside periorbital area)
-Chemotherapy: 5% imiquimod
-Photodynamic therapy

www.ophthalmobytes.com

Image from Rajan Eye Care Hospital

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