Advanced Periocular Basal Cell Carcinoma with Orbital Invasion: Update on Management and Treatment Advances

Figure 5

(a) Recurrent basal cell carcinoma (BCC) in medial canthus (patient 9). Mass adherent to deep plane that limits ocular motility. (b) Computed tomography scan confirms infiltration of the anterior orbit and anterior portion of the medial rectus muscle. (c) Nuclear magnetic resonance shows complete disappearance of the mass following treatment only with vismodegib (patient 9). (d) Recurrent BCC (patient 16) in medial canthus in a patient with Gorlin’s syndrome with infiltration of the anterior orbital tissue. Treatment consisted in removal of the tumor maintaining the eyeball, with infiltrated margins, and subsequent treatment with vismodegib. (e) Reconstruction with flap and grafts. (f) Good result and no recurrence after treatment with vismodegib. (g) Recurrent micronodular basal cell carcinoma infiltrating anterior orbital tissue and lacrimal sac (patient 24). Treatment consisted in extirpation of the mass and lacrimal sac, maintaining the eyeball. (h) Reconstruction combining island pedicle flap and glabellar flap. Subsequent treatment with vismodegib after surgery due to infiltrated margins. (i) Good cosmetic result and no recurrences after surgery.