Basal Cell Carcinoma of the Eyelid

Basal Cell Carcinoma of the Lid

Features:

·      Usually occurs on the lower eye lid.

·      Usually has a nodular with a pearly surface and telangiectatic vessels.

·      May appear as morphea form or sclerosing form.

Guideline:

Whenever there is found a mass on the eyelid or adnexa, the standard scheme of examination of a lump should be followed.

Standard Scheme for examination of a Lump (link to step)

Examination:

• Describe the findings of Observation

  • Describe the skin complexion of the patient 

  • On inspection there is an ______ (ovoid / round / disfigured), __________ (pigmented / non-pigmented / depigmented / skin colored) mass,

  • located on the lower eyelid, involving the medial half of the lower eyelid,

  •    _______ (sparing / involving) the eyelid margin,

  • about 5x3 mm in size, with sharp demarcation from the surrounding tissue

  • The surface is (Pearly/ ____) with surface telangiectasis, and rolled edges

  •  Mucopurulent / blood-stained discharge

  • There is loss of / no loss of eyelid architecture (loss of lashes, deformed tarsal plate)

• Describe the findings of Palpation –

  •  The mass is ________(tender / non-tender) to touch

  • the lesion is __________ (nodular / multinodular / diffusely infiltrating

  • the temperature of the lesion is comparable to the surrounding skin,

  • the nodule is __________ (soft, firm, Hard) in consistency.

  •  it is __________ (adherent to the skin/mobile under the skin) but__________ (attached / not attached) to the underlying structures and is _______- (mobile / immobile).

  • The mass is non-pulsatile and has no fluctuation or reducibility

  • The draining lymph nodes are non-palpable.   

• Check if the punctum is involved (suggestive of potential orbital extension).

• Check if there is diplopia or limitation of extraocular motility

• Assess the amount of skin laxity which would be important in reconstructive surgery.

• (As in all cases of anterior segment, look for some other clinical finding other than the lump)

Narration:

Questions:

1. What is the differential diagnosis?

2. What are the treatment options for basal cell carcinoma?

• Cryotherapy

• Radiotherapy

• Excision. This is the treatment of choice. Two techniques may be used in widely infiltrating (morpheaform) tumours to ensure complete excision:

  • The frozen section techniques. After the tumour has been excised, 1-2 mm wide strips of tissue is excised from the adjacent tissue for frozen section examination. Reconstruction is undertaken only when all margins are found to be tumour free.

  • Mohg's micrographic surgery. Tissue is removed in lamellar layers which provide a three- dimensional mapping of the tumour excision. Compare with the above, it allows for retention of the maximum amount of tissue.