Basal cell carcinoma

Basal cell carcinomas occur frequently on the face and particularly around the eye. They have a predilection for the lower lid margin and adjacent inner canthus. It is unusual for the upper eyelid to be involved. Surgical excision, with either local transposition or graft repair, is often appropriate. However, in more extensive lesions or where surgery is contraindicated, radiotherapy can be given.

Radiotherapy can be used as primary treatment, following excision when the surgical margins are positive or where a recurrence has occurred. Superficial X-rays (100-150 kV) are appropriate (e.g. 45 Gy in 10 daily fractions). It is easy to protect the eye using an internal eye shield and lead cut-outs. Margins around the lesion should be 5 mm, but increased if electrons are used rather than orthovoltage X-rays.

If the nasolacrimal duct is involved by the tumour, epiphora will occur due to duct stenosis. Cannulation or stenting of the duct may be necessary later. However, carefully planned and fractionated radiotherapy should not, of itself cause duct stenosis.

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