Purpose

Basal cell carcinoma (BCC) accounts for approximately 80% of non-melanoma skin cancers, with periocular BCCs comprising 20% of cases. Although metastatic risk is low, periocular BCCs are considered ‘high-risk’ due to potential local invasion affecting ocular function and aesthetics. Diagnostic delays of 19-25 months remain common. We assessed the prevalence of “opportunistic” BCC referrals.

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Methods

We retrospectively reviewed 300 periocular biopsies performed by the Oculoplastics Department at Musgrove Park Hospital, Taunton UK, between July 2024 and November 2025. Using the Medisight e-record, we examined the ophthalmic history of patients with confirmed malignant lesions. Clinic visits in the 12 months before biopsy – where the lesion may have already been visible, but no referral was made, were considered “potential missed referrals”.

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Results

Of the 146 malignant biopsies, 127 contained BCC (87%). Seventeen of these patients had been seen by an ophthalmology outpatient service within the previous 12 months. Thirteen of these patients attended one subspecialty clinic without referral for a suspicious lesion (76.5%), whilst two patients attended two separate services without referral by either team (15.4%). Virtual clinics accounted for 72% of potential missed referrals.

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Conclusion

Opportunistic findings of periocular lesions may be overlooked in ophthalmology outpatient settings. Delayed diagnosis may impact treatment complexity, invasiveness, cost, and surgical outcomes. Virtual clinics may reduce lesion detection due to lack of in-person examination. Intentional screening questions to detect new skin changes, and increased clinician awareness of referral criteria, may help reduce delays in BCC diagnosis.

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Additional Authors

First name	Last name	Base Hospital / Institution
Myles	Potter	Musgrove Park Hospital
Edward	Saxby	Musgrove Park Hospital
Rhys	Davies	Musgrove Park Hospital

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