1. Clinico-Pathological Conference (CPC) Meet Karpagam Medical College Hospital 27-02-2015

2. Basal Cell Carcinoma (BCC) – Eyelid with Orbital Exenteration

3. BCC Eyelids Mrs. X 80/F Ulcer over left upper eyelid 8 months Loss of vision in left eye – 4 months Past H/O surgery for BCC 2 years back - excision O/E – No nodes Dx- Recurrent BCC Lt Upper Eyelid

4. Pre operative skin preparation and marking for incision

5. Circum-orbital incision to expose the orbital pad of fat

6. Dissection of eyeball sparing the periosteum and ligating all vessels

7. Exenteration done with osteotomy of lateral orbital wall due to suspicion of infiltration laterally

8. Post operative specimen – Anterior view

9. Post operative specimen – Medial view

10. Immediate postoperative period

11. Post operative Day 3

12. Post operative Day 7

13. MALIGNANT EYELID TUMOURS 1. Basal cell carcinoma 2. Squamous cell carcinoma 3. Meibomian gland carcinoma 4. Melanoma 5. Kaposi sarcoma 6. Merkel cell carcinoma 7. Treatment

14. Basal Cell Carcinoma - Important Facts 1. Most common human malignancy 2. Usually affects the elderly 3. Slow-growing, locally invasive 5. 90% occur on head and neck 6. Of these 10% involve eyelids 7. Accounts for 90% of eyelid malignancies 4. Does not metastasize

15. Frequency of location of basal cell carcinoma Lower lid - 70%Medial canthus - 15% Upper lid - 10%Lateral canthus - 5%

16. Nodular basal cell carcinoma Early Shiny, indurated nodule Surface vascularization Slow progression Advanced May destroy large portion of eyelid

17. Ulcerative basal cell carcinoma (rodent ulcer) Early Chronic ulceration Advanced Raised rolled edges and bleeding

18. Sclerosing basal cell carcinoma Indurated plaque with loss of lashes Advanced Spreads radially beneath normal epidermis Early May mimic chronic blepharitis Margins impossible to delineate

19. Histology of basal cell carcinoma Downgrowth from epidermis of small, dark atypical basal cells Peripheral palisading Cell nests in fibrous stroma

20. Treatment Options 3. Cryotherapy 2. Radiotherapy Small BCC not involving medial canthus 1. Surgical excision Method of choice Small and superficial BCC irrespective of location Adjunct to surgery in selected cases

21. Lower eyelid reconstruction following tumour excision Mustarde cheek rotation flap for large defect Tenzel flap for moderate defect Direct closure of small defect ab a b b