Presentation
Extensive ulceration and soft tissue swelling in right side upper lid and upper midface.
Patient Data
There is a large scale and ulcerative soft tissue mass like thickening within right side upper eyelid extended within related medial canthus, nasal walls and frontal sinus and calvarium bones and soft tissues with large scale malignant type irregular margin sclerotic thickening of the bones. The lesion also invaded the right side nasolacrimal duct and both sides fronto-ethmoidal recess with resultant obstructive effect and thick mucosa and fluid accumulation within the fronto-ethmoidal sinus regions.
Microscopic description: There are irregular clumps of basaloid cells that originated from the basal layer of the epidermis with extensive dermis involvement and limited peripheral palisading. Invasion to adjacent soft tissues and bone trabeculae is noted. There is also a loose stroma with some foci of fibrosis.
The report has been prepared by Dr. Nozarian Zohre, the pathologist.
Case Discussion
Basal cell carcinoma is the most common malignancy of the skin and also the most common eyelids malignancy. The proximity of the eyelids to the eye globes constituted the eyelids a critical location of the tumor. Clinical nodular ulcerative and histological nodular basal cell carcinoma are the most common types in eyelids. The tumor is locally invasive and has a high rate of recurrence and the recurrent basal cell carcinoma is more destructive and aggressive and has a poorer response to treatment. The basal cell carcinoma of the eyelid is the leading cause of eyelid reconstructive surgery. Gorlin-Gortz syndrome is a rare autosomal dominant condition that can be associated with eyelid basal cell carcinoma.
Orbital MDCT can clearly detect and evaluate the deep extension of the tumor and bone destruction but even in the absence of the bone erosion or destruction on MDCT images adjacent bone must be surgically removed and histologically evaluated. The MRI with and without gadolinium intravenous injection can depict the medial canthal ligament and perineural invasion and postseptal extension of the tumor.
The most common treatment for eyelid basal cell carcinoma is surgical resection with frozen section for evaluation of the margin of the mass but other options include cryotherapy, radiotherapy, laser surgery, chemotherapy, and photodynamic therapy.