Basal Cell Carcinoma

Basal cell carcinoma (BCC) is not technically an "eye cancer," but it is the most common type of cancer affecting the eyelid and surrounding skin, known as periocular skin cancer.

Basal cell carcinoma (BCC) is the most common type of skin cancer, typically caused by long-term exposure to ultraviolet (UV) radiation from the sun or tanning beds. Although it rarely spreads (metastasizes), BCC can be locally invasive, damaging surrounding tissues if left untreated.

In the context of ocular or periocular cancer, BCC often occurs on the eyelids, especially the lower lid, due to high sun exposure in that area. It may present as a pearly bump, ulcer, or scaly patch, sometimes with visible blood vessels or crusting. It grows slowly but can invade the eyelid margin, tear ducts, and even the orbit in advanced cases.

Diagnosis is confirmed with a biopsy, and treatment depends on the tumor’s size, depth, and location. Common approaches include surgical excision, Mohs micrographic surgery (for tissue preservation), radiation therapy, or topical treatments for superficial lesions.

While BCC has a high cure rate, regular follow-up is essential due to the risk of recurrence and the possibility of developing additional skin cancers in sun-damaged areas.

🧿 Basal Cell Carcinoma (BCC) Fact Sheet

Cancer Type: Skin Cancer (Non-Melanoma)
Most Common Location (Ocular): Eyelids and surrounding periocular skin
Website Reference: OcularCancer.com

🔍 What is Basal Cell Carcinoma?

Basal Cell Carcinoma (BCC) is the most common form of skin cancer and frequently occurs on sun-exposed areas such as the eyelids, face, and neck. Although BCC grows slowly and rarely spreads (metastasizes), it can be locally invasive and cause significant tissue destruction if not treated early - particularly in sensitive areas like the eye and surrounding structures.

📊 Key Facts:

Most common eyelid cancer (accounts for ~85 - 90% of eyelid malignancies)
Global prevalence: 2 - 3 million cases annually (all forms)
Highest risk locations: Lower eyelid, medial canthus (inner corner of the eye)
Gender: Slightly more common in men
Age of Onset: Most common in people over 50

🌞 Causes & Risk Factors:

Chronic sun exposure (UV radiation) - #1 cause
Fair skin, light eyes, light hair
History of frequent sunburns
Age > 50
Immunosuppression (e.g., transplant patients)
Exposure to arsenic or radiation
Genetic syndromes: Basal Cell Nevus Syndrome (Gorlin Syndrome)

👁️ Signs and Symptoms (Periocular/Facial BCC):

Painless bump or nodule on the eyelid or near the eye
Ulcer that does not heal (“rodent ulcer”)
Scab or sore that repeatedly bleeds and crusts
Pearl-like or translucent appearance
Loss of eyelashes near the lesion
Eyelid distortion or notching
Tear duct obstruction (when near inner canthus)

🩺 Diagnosis:

Clinical examination by dermatologist or oculoplastic specialist
Dermatoscopy (magnified skin imaging)
Biopsy (shave, punch, or excisional) for histological confirmation
Imaging (MRI/CT) in larger or deeply invasive tumors near the orbit or sinuses

🧬 Histologic Subtypes:

Nodular BCC (most common)
Superficial BCC
Morpheaform (sclerosing) – more aggressive and infiltrative
Pigmented BCC – often confused with melanoma

🧪 Treatment Options:

Surgical excision with histopathologic margin control
Mohs micrographic surgery: Gold standard for facial/eyelid lesions due to precision and tissue preservation
Cryotherapy: For superficial lesions
Radiation therapy: For non-surgical candidates
Topical therapies: Imiquimod or 5-fluorouracil for select superficial cases
Oral targeted therapies (e.g., vismodegib): For locally advanced or recurrent BCC

🧿 Ocular Considerations:

Lesions near the medial canthus may invade the lacrimal system, orbit, or sinus
Untreated tumors may cause vision loss, eye displacement, or orbital invasion
Complex cases may require oculoplastic surgery or multidisciplinary care

🎯 Prognosis:

Excellent prognosis with early detection and treatment
Cure rates >95% with Mohs surgery
Local recurrence: ~5 - 10%, higher in morpheaform BCC
Metastasis is extremely rare (<0.1%), but possible in neglected or deeply invasive cases

🔄 Follow-Up & Monitoring:

Annual skin and eye exams
More frequent follow-up for patients with:
- Multiple previous skin cancers
- Immunosuppression
- High-risk histologic subtypes

❤️ Support & Resources:

Dermatologic and oculoplastic specialists
Cancer support groups for facial disfigurement or reconstructive surgery
Sunscreen and UV protection education
Mental health support for cosmetic/visual changes

📌 Key Takeaways:

Basal Cell Carcinoma is common but serious - especially near the eye.
UV protection and early detection are key to prevention and successful treatment.
Periocular BCCs require specialized care to preserve vision, function, and appearance.
Mohs surgery offers the best outcomes for sensitive facial areas.