Purpose

To present a case with detailed images illustrating a ‘worst case’ scenario after insufficient removal of a basal cell carcinoma in the medial canthal region.

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Methods

A single patient with recurrent basal cell carcinoma was assessed and treated at a tertiary referral center. Histopathology from the initial biopsy and curettage in 2019, as well as from the biopsy performed by the referring dermatologist in 2026 was obtained through the Pathology and Genetics Data Bank. Histopathology of the subsequent resections was obtained directly from the local Department of Pathology. The patient’s medical records and pre- and perioperative images were reviewed.

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Results

Repeated surgeries (n=3) were required due to positive margins on frozen and formalin sections, especially in depth. Ultimately, it was necessary to perform orbital exenteration due to deep spread of the carcinoma into the periocular and nasal tissue.

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Conclusion

This case highlights the importance of radical removal of cutaneous basal cell carcinoma in the periocular region, especially in the medial canthal region. Curettage is not an appropriate treatment in this area because the tumor can expand subclinically, leading to potentially large recurrences that require reconstruction and in worst case also orbital exenteration. It also shows how challenging it can be to determine the margins of a residual infiltrative tumor, supporting the use of margin-controlled excision with frozen section analysis in this region.

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Additional Authors

First name	Last name	Base Hospital / Institution
Camilla	Sangill	Vejle Eye Department, Vejle Hospital

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