Lower Eyelid Reconstruction after Basal Cell Carcinoma Removal - A Decision Management Tool

Purpose: To describe the clinical features in patients presenting with a primary basal cell carcinoma (BCC) involving the lower lid and/or adjacent inferior periocular area, and present simple surgical guidelines for reconstruction based on the lesion location and size. Design: Retrospective observational case series. Methods: This is an institutional, observational study involving 64 patients with a single primary BCC affecting the lower eyelid +/- adjacent periocular area. We included only adults who underwent primary surgical excision of the tumor with margin control. We excluded all patients with prior history of an eyelid malignancy, recurrent tumors, and invasive disease beyond the orbital septum. Results: Small-moderate full-thickness defects ( 25mm) had a complex reconstruction, and all used a Mustarde cheek rotational flap for the anterior lamella. The posterior lamella was reconstructed with: a tarso-conjunctival graft from the upper lid +/- a chondro-mucosal graft from nasal septum +/- a periosteal flap. Lesions in the medial periocular area (not involving the full-thickness eyelid) were repaired with a bilobed or rhomboid myocutaneous flap +/- an island advancement flap from the nasojugal area. Conclusions: Our goal is to provide a basic framework for pre and intra-operative decision making that leads to successful functional and aesthetic appearance after lower eyelid reconstruction after basal cell carcinoma removal