Advanced Periocular Basal Cell Carcinoma with Orbital Invasion: A Case Report

Abstract

Introduction: Basal cell carcinoma (BCC) is the most common eyelid malignancy, known for its slow progression and local invasiveness. In rare, neglected cases, it may invade the orbit, necessitating aggressive surgical management.
Case Report: A 62-year-old male presented with an 8-year history of a gradually enlarging, painless lesion over the right lower eyelid, accompanied by progressive diminution of vision and discharge. Clinical evaluation and imaging showed orbital invasion, and an incisional biopsy confirmed basal cell carcinoma (BCC). The patient underwent extended orbital exenteration of the right eye with medial maxillectomy, followed by reconstruction using a temporalis muscle flap and a paramedian forehead flap. Histopathological examination confirmed BCC with erosion of the underlying bone and tumor deposits suggestive of optic nerve involvement. Although all peripheral margins were clear, the posterior soft tissue margin was positive. Post-operative recovery was uneventful, and the patient was referred for adjuvant radiotherapy following multidisciplinary tumor board review to address residual disease and reduce the risk of recurrence.
Conclusion: This case shows the potential for severe local invasion in untreated periocular BCC and the importance of early diagnosis and multidisciplinary management to prevent extensive disfigurement and improve outcomes.