Purpose

Medial canthal lesions are frequently managed with a high suspicion for basal cell carcinoma (BCC) due to their predilection for malignancy and potential for local invasion. However, inflammatory dermatoses can closely mimic periocular skin cancer both clinically and dermoscopically, posing a diagnostic and management challenge in oculoplastic practice. We report a case of a clinically suspicious medial canthus lesion initially concerning for BCC, ultimately proven to be lichenoid inflammation and successfully treated non-surgically.

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Methods

An 87yo woman presented with a right medial canthus pigmented lesion, associated with gradual enlargement and intermittent crusting. Clinical examination raised concern for BCC, and an excisional biopsy was performed. Histopathological analysis revealed lichenoid inflammation with no evidence of malignancy.

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Results

Given the discordance between clinical suspicion and histology, the case was discussed at a multidisciplinary oculoplastic and skin oncology meeting. A conservative management approach was adopted, and topical tacrolimus 0.1% ointment was prescribed for three months.On follow-up, the lesion demonstrated marked complete resolution.

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Conclusion

This case highlights an important diagnostic pitfall in oculoplastic practice: inflammatory periocular dermatoses may closely simulate BCC. Histopathological confirmation is essential prior to definitive surgical management, especially when clinical suspicion and biopsy findings diverge. Furthermore, this case supports the role of topical immunomodulatory therapy as a safe and effective option in selected benign inflammatory periocular lesions, potentially avoiding unnecessary surgical intervention. Lichenoid inflammatory lesions of the medial canthus can clinically mimic BCC. This case underscores the importance of clinicopathological correlation in oculoplastic oncology and demonstrates that topical tacrolimus may offer an effective non-surgical treatment option in biopsy-proven benign inflammatory lesions.

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Additional Authors

First name	Last name	Base Hospital / Institution
Anna	Gkountelia	Barking, Havering And Redbridge University Hospitals Nhs Trust

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