Orbital invasion by periocular basal cell carcinoma

ObjectivesTo present a large series of patients with orbital invasion by periocular basal cell carcinoma (BCC).DesignRetrospective, noncomparative, interventional case series.PatientsAll cases diagnosed with orbital invasion by periocular BCC between January 1985 and July 2004 in 3 Orbital Units in Australia.MethodsThe clinical records of all patients were reviewed.Main outcome measuresPatients' demographics, clinical presentation, histologic subtypes, treatment modalities, recurrence rate, and tumor-related death.ResultsThere 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.ConclusionsOrbital 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