Basal cell carcinoma
 

. There is a lesion in the lower lid (much commoner than the upper lid) which is nodular with an ulcerated centre. The surface is pearly and has telangiectasia. Sometimes, the lesion may present as morphea or sclerosing form. Further examination: check if the lesion is attached to the underlying structure by gently moving the lesion check if the puntum is involved (if present, there is a potential risk of orbital extension) look for loss of eyelashes (this is indicative of malignancy if the nature of the lesion is uncertain) assess the amount of skin skin laxity which would be important in reconstructive surgery look for other ocular signs as basal cell carcinoma is unlikely to form the main physical sign in the examination.

Questions:

1. What is the differential diagnosis of basal cell carcinoma?

Answer
Other malignant tumours such as squamous cell carcinoma, sebaceous cell carcinoma and amelanotic melanoma.

2. What are the treatment options for basal cell carcinoma?

Answer
cryotherapy
radiotherapy
excision. This is the treatment of choice. Two techniques may be used in widely infiltrating tumours to ensure complete excision:
a. the frozen section techniques. After the tumour has been excised. 1-2 mm wide strips of tissue is excised form the adjacent tissue for frozen section examination. Reconstruction is undertaken only when all margins are found to be tumour free.
b. Mohg's micrographic surgery. Tissue is removed in lamellar layers which provide a three-dimensional mapping of the tumour excision. Compared with the above, it allows for retention fo the maximum amount of tissue.

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