Advanced Periocular Basal cell carcinoma with Orbital Involvement: Toward Function-Preserving Treatments
Author: Consuelo Mata-Beltran
Base Hospital / Institution: 12 de Octubre University Hospital
Abstract ID: 25-458
Purpose
To evaluate the management of periocular basal cell carcinoma (BCC) with orbital invasion, focusing on the efficacy of hedgehog pathway inhibitors (HPIs), particularly vismodegib, compared to traditional surgical options such as orbital exenteration.
Methods
A retrospective analysis was conducted on 24 patients with histologically confirmed periocular BCC and orbital invasion treated at a single tertiary center between 2011 and 2021. Tumors were evaluated clinically, radiologically, and histologically. Treatment modalities included orbital exenteration, globe-sparing surgery, and vismodegib (as monotherapy or adjuvant therapy in margin-positive cases). Patients were followed up clinically and radiologically to date.
Results
Of the 24 patients (mean age: 72 years), 71% presented with recurrent BCC tumors, most of them infiltrative in subtype. The medial canthus was the most common site (66%). Nine patients underwent exenteration, mostly in early years of the study, with one recurrence and tumor-related death. Twelve patients were treated with globe-sparing surgery; in four cases with positive margins, where vismodegib was added postoperatively. No recurrences were observed in any of the patients treated with adjuvant vismodegib. Three patients received vismodegib as monotherapy; one achieved complete remission, while the other two discontinued treatment due to adverse effects or comorbidities. Side effects were generally mild and manageable.
Conclusion
Periocular basal cell carcinoma with orbital invasion poses complex therapeutic decisions. While exenteration remains necessary in some advanced cases, HPIs like vismodegib provide an effective, globe-preserving alternative, particularly when used as adjuvant therapy after conservative surgery. These results support a paradigm shift toward personalized, function-preserving management strategies in advanced periocular BCC.
Additional Authors
| First name | Last name | Base Hospital / Institution |
|---|---|---|
| Alvaro | Bengoa-Gonzalez | 12 de Octubre University Hospital |
| Maria-Dolores | Lago-Llinas | 12 de Octubre University Hospital |
| Regina-Maria | Lopez-Ladron | 12 de Octubre University Hospital |
| Silvia | Perez-Trigo | 12 de Octubre University Hospital |
