| Basal Cell Carcinoma  SIGNS AND SYMPTOMS
Basal cell carcinoma is the most common malignancy of the eyelid,
accounting for over ninety percent of all cancerous lid lesions. Often, this tumor is
discovered during routine slit lamp evaluation. There is usually no associated pain or
discomfort. Basal cell carcinoma is more common in older, fair-skinned individuals,
especially with a history of prolonged or excessive exposure to sunlight. The lower lid
margin and medial canthus are the most common areas involved.
The basal cell lesion presents in one of three ways: (1) the nodular
form appears as a small, translucent, raised area with poorly defined edges, and is firm
to the touch; (2) the classic ulcerative presentation is a nodular lesion that over time
has developed telangiectasia (a reddish hue caused by persistent, and virtually permanent,
dilation of capillaries) along the surface and an atrophied inner portion, creating a
"pearly," indurated outer margin with an excavated center; and (3) less
frequently, the sclerosing or morpheaform basal cell carcinoma form, which has a firm,
pale, waxy yellow plaque with indistinct borders.
PATHOPHYSIOLOGY
While there is no single known cause for all forms, there is a distinct
association with increasing age and exposure to ultraviolet radiation. In addition,
Caucasians have a much greater chance of developing basal cell carcinoma than other races.
The progression of this tumor is, in most cases, exceedingly slow. If left untreated,
however, the lesion may in time invade deeper structures. Fortunately, metastasis is rare,
and complete recovery is possible with proper therapy.
MANAGEMENT
Basal cell carcinoma can be treated with surgical excision, radiation
therapy or chemotherapy. The preferred course for most cases is surgery, with broad
margins to ensure complete removal. Local radiation therapy and/or systemic chemotherapy
can manage basal cell carcinoma when surgery is intolerable or refused by the patient.
Both of these modalities carry significant side effects, however, and neither is as
effective as surgical intervention.
CLINICAL PEARLS
- Basal cell carcinoma is rarely life-threatening because of its
non-metastatic, slow-growing nature. However, this tumor does possess the capacity, over
time, to cause significant local destruction, and must always be treated appropriately.
- Early biopsy is often the key to diagnosis. Biopsy all suspicious lid
lesions which demonstrate irregular growth, changes in color or appearance, or purulent or
bloody discharge to rule out cancer. You should refer confirmed malignancies promptly to
an oculoplastics specialist or, if possible, an ocular oncologist.
Other reports in this section
|
