Purpose

To present the management of an extensive lower eyelid basal cell carcinoma using radical excision and Hughes reconstruction.

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Methods

An 82-year-old male presented with a two-month history of a nodular lesion involving two-thirds of the right lower eyelid, initially misdiagnosed as chalazion. Full-thickness excision with clinically clear margins resulted in a defect exceeding 60% of the horizontal eyelid length. Reconstruction was performed using a two-stage Hughes procedure, with a tarsoconjunctival flap from the upper eyelid for posterior lamella restoration and a free skin graft for anterior lamella reconstruction. Flap division was completed at 4 weeks.

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Results

Histopathology confirmed basal cell carcinoma with clear margins. No early or late complications, including flap ischemia, graft loss, entropion, ectropion, or eyelid instability, were observed. At follow-up, the patient remains disease-free with satisfactory functional and aesthetic outcomes.

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Conclusion

Reconstruction of full-thickness lower eyelid defects exceeding 50% of the horizontal length requires structurally stable posterior lamella restoration and reliable vascular supply. The upper eyelid tarsoconjunctival flap provides a well-vascularized, anatomically compatible substrate with sufficient mechanical strength for eyelid margin reconstruction. The two-stage approach allows controlled vascularization before flap division, reducing the risk of ischemia, instability, or deformities. In parallel, anterior lamella reconstruction with a free skin graft offers functional adequacy and satisfactory aesthetic outcomes. Radical oncologic excision combined with Hughes reconstruction enables simultaneous achievement of oncologic safety and functional restoration in extensive lower eyelid basal cell carcinomas. This technique remains a gold standard in lower eyelid reconstruction for large defects, providing a stable, well-vascularized, and long-term reliable outcome.

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Additional Authors

First name	Last name	Base Hospital / Institution
Christos	Trivizas	General Anticancer Oncological Hospital of Athens “Saint Savvas”
Andromachi	Fermanoglou	General Anticancer Oncological Hospital of Athens “Saint Savvas”
Angeliki	Tsingouni	General Anticancer Oncological Hospital of Athens “Saint Savvas”
Dimitra	Archontouli	General Anticancer Oncological Hospital of Athens “Saint Savvas”
Ilinka	Mis	General Anticancer Oncological Hospital of Athens “Saint Savvas”

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