Abstract ID: 26-604
Excision of Ulcerated Basal Cell Carcinoma of the Lower Eyelid with Reconstruction Using the Modified Hughes Technique
Author: ANDREA MORATO Base Hospital / Institution: HCFMUSP
Presentation Type: Video Presentation
Purpose
To report a case of recurrent ulcerated basal cell carcinoma (BCC) of the lower eyelid treated with complete excision and reconstruction using the with the Hughes tarsoconjunctival flap associated with a periosteal flap.
Methods
A 75-year-old woman presented with progressive growth of a recurrent lesion involving the central and lateral portions of the left lower eyelid. She had undergone previous excision in the same area two years earlier, with histopathological diagnosis of BCC. Ophthalmologic examination showed best-corrected visual acuity of 20/20 in the right eye and 20/25 in the left eye, with otherwise unremarkable anterior and posterior segment findings. Examination revealed a violaceous indurated lesion with ulceration and extension to the lateral canthus. Excisional biopsy measured 2.6 × 0.8 × 0.7 cm and confirmed ulcerated nodular BCC involving the deep dermis and focally the orbicularis oculi muscle. Complete surgical excision was performed, followed by reconstruction with the Hughes tarsoconjunctival flap associated with a periosteal flap
Results
Intraoperatively, a 4.2 cm full-thickness lower eyelid defect with loss of lateral canthal anatomy was identified after tumor excision. Reconstruction was completed in two stages using the Hughes technique combined with periosteal flap support. Late postoperative follow-up demonstrated satisfactory eyelid contour, preserved function, adequate closure, and good symmetry compared with the contralateral side, without evidence of recurrence.
Conclusion
BCC is the most common malignant eyelid tumor, predominantly affecting the lower eyelid. Reconstruction of defects involving more than 50% of the eyelid margin remains challenging due to the need to restore both function and anatomy. The Hughes flap remains a reliable option for extensive lower eyelid defects, providing favorable functional and cosmetic outcomes. Adjunctive procedures, such as periosteal flap reconstruction, may be necessary in cases with lateral canthal involvement.
Additional Authors
| First name | Last name | Base Hospital / Institution |
|---|---|---|
| Thiago | D’alcantara | HCFMUSP |
| Renata | Maia | HCFMUSP |
| Suzana | Matayoshi | HCFMUSP |
| Laura | Goldfarb | HCFMUSP |