Elsevier

Ophthalmology

Volume 112, Issue 4, April 2005, Pages 717-723
Ophthalmology

Original article
Orbital Invasion by Periocular Basal Cell Carcinoma

https://doi.org/10.1016/j.ophtha.2004.11.036Get rights and content

Objectives

To present a large series of patients with orbital invasion by periocular basal cell carcinoma (BCC).

Design

Retrospective, noncomparative, interventional case series.

Patients

All cases diagnosed with orbital invasion by periocular BCC between January 1985 and July 2004 in 3 Orbital Units in Australia.

Methods

The clinical records of all patients were reviewed.

Main Outcome Measures

Patients' demographics, clinical presentation, histologic subtypes, treatment modalities, recurrence rate, and tumor-related death.

Results

There were 64 patients (49 males) with a mean age of 70±13 years. Most tumors (84.4%) were recurrent or previously incompletely excised, and the medial canthus was most frequently involved (56.2%). Signs suggestive of orbital involvement included a mass with bone fixation (35.7%), limitation of ocular motility (30.4%), and globe displacement (17.6%). There were no signs suggestive of orbital invasion in 35.7%. Most patients (51.6%) had infiltrative histologic findings, and perineural invasion was present in 19.3%. Treatment modalities were mainly exenteration alone or combined with radiotherapy. During a mean follow-up period of 3.6 years, 3 cases of recurrence (4.7%) were diagnosed. Only 1 patient (1.6%) died from tumor-related causes.

Conclusions

Orbital invasion by periocular BCC is an uncommon event that may be associated with significant ocular morbidity and, rarely, death. Because orbital invasion may often be clinically silent, clinicians need to be alert to the possibility in high-risk tumors and consider appropriate imaging. Surgical treatment with exenteration or excision, with or without radiotherapy, results in a low recurrence and mortality rate.

Section snippets

Patients and Methods

This is a 3-center retrospective study of all patients with orbital invasion by periocular BCC, who were seen between January 1985 and July 2004 (Royal Adelaide Hospital, January 1985–July 2004;(Royal Victorian Hospital, January 1989–July 2004; Royal Brisbane Hospital; January 1992–July 2004).

The criteria for selection were all cases of histologically confirmed BCC with radiologic or histologic evidence of orbital invasion. Orbital imaging with computed tomography (CT) or magnetic resonance

Results

There were 64 patients with a mean age of 70±13 years (median, 72 years; range, 35–93 years). Fifteen were females (23.4%) and 49 males (76.6%) (P<0.0001 compared with equal frequencies of primary periocular BCC in males and females as reported previously2). All patients were Caucasians.

In 54 patients (84.4%), this was a recurrent tumor, and in 10 patients (15.6%), it was the first presentation of the tumor. The mean duration from the first tumor excision to the diagnosis of orbital invasion in

Discussion

In this report, we presented the largest series of patients with orbital invasion by periocular BCC. It is an uncommon complication, and the reported incidence is considered to be lower than 5%. Payne et al7 reported that 8 of 273 periocular BCC (3.6%) required exenteration, and Perlman and Hornblass8 reported similar results (3.8%) in 106 patients with BCC. In more recent studies, Howard et al4 identified 11 patients (2.5%) with orbital invasion from a series of 440 patients with periocular

References (36)

  • M. Sexton et al.

    Histologic pattern analysis of basal cell carcinoma: study of a series of 1039 consecutive neoplasms

    J Am Acad Dermatol

    (1990)
  • M.T. Bastiaens et al.

    Differences in age, site distribution, and sex between nodular and superficial basal cell carcinoma indicate different type of tumors

    J Invest Dermatol

    (1998)
  • Z.B. Niazi et al.

    Perineural infiltration in basal cell carcinomas

    Br J Plast Surg

    (1993)
  • R. Malhotra et al.

    The Australian Mohs database, part 1Periocular basal cell carcinoma experience over 7 years

    Ophthalmology

    (2004)
  • A. Takeda et al.

    Late retinal complications of radiation therapy for nasal and paranasal malignancies: relationship between irradiated-dose area and severity

    Int J Radiat Oncol Biol Phys

    (1999)
  • H.W. Walling et al.

    Aggressive basal cell carcinoma: presentation, pathogenesis, and management

    Cancer Metastasis Rev

    (2004)
  • SAS [computer program]. Version 9.1 Cary, NC: SAS Institute Inc.,...
  • J.W. Payne et al.

    Basal cell carcinoma of the eyelidsA long-term follow-up study

    Arch Ophthalmol

    (1969)
  • Cited by (0)

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