Periocular basal cell carcinoma—current treatment concepts
Yongwei Guo, Alexander C. Rokohl, A Kopecký, Ludwig M. Heindl
Abstract
Abstract: Basal cell carcinoma (BCC) is by far the most common human skin cancer. In Caucasians, BCCs account for around 90% of periocular malignancies. However, periocular BCCs are usually neglected due to their slow and painless growth, unless presenting complaints, e.g., large size, bleeding, recurrent infections of the tumor, or secondary symptoms resulting from adjacent structures involvement as epiphora, limited eye globe motility as well as globe displacement. Moreover, although the tumor can usually be cured with local excision, local recurrence can occur in up to 20% of eyelid BCC cases. Recurrent BCCs of the eyelid show a poorer overall prognosis than the primary ones. In addition, the management of advanced diseases, such as orbital or intracranial invasion as well as metastatic lesions, is challenging and often involves a multidisciplinary approach. In this paper, we reviewed the recent research progress of pathogenesis, clinical presentation, and therapeutics of periocular BCCs. We introduced the molecular pathogenesis of BCCs [multi-step ultraviolet (UV)-induced carcinogenesis model, genetic predisposition, and epigenetic changes], clinical classification, and tumor-node-metastasis (TNM) clinically stage of eyelid skin BCCs. We also emphasized the treatment of BCCs, i.e., surgical resection, oculoplastic reconstruction, and alternative therapies (radiation therapy, systemic therapy, topical therapy, and prophylactic therapy). In the end, we proposed that considering the possible iatrogenic damage to the surface of the eye by surgical excision, the treatment of periocular BCCs is recommended to be performed by or in the presence of an oculoplastic surgeon.