Multidisciplinary Management of Orbit-Invasive Basosquamous Carcinoma with Intracranial Extension
Author: Poh Wein Loh
Base Hospital / Institution: Plastic and Reconstructive Surgery Department of Austin Health, Melbourne Australia
ePoster presentation
Abstract ID: 25-236
Purpose
To describe the multidisciplinary management of unresectable basosquamous carcinoma.
Methods
A 62-year-old woman presented with a progressive ulcerative facial mass predominantly affecting the right eye with involvement of the entire medial canthus on the left side. The right eye had no light perception while the left eye had visual acuity of 6/18, improving to 6/9 with a pinhole. MRI demonstrated extensive local invasion with intracranial extension without distant metastases. Biopsy confirmed basosquamous carcinoma. First-line systemic therapy with Vismodegib (a Hedgehog pathway inhibitor) was initiated as the lesion was unresectable. Tumor responded to Vismodegib resulting in cicatrizing changes of the right orbit, forehead, and left medial orbit. However, the right globe spontaneously ruptured with corneal melt due to lack of eyelids coverage. She underwent right eye evisceration and left medial tarsorrhaphy for exposure keratopathy. Biopsies at the time of surgery did not show evidence of residual tumour.
Results
Our case had several poor prognostic features, such as squamous differentiation, tumour diameter >2 cm, and orbital and intracranial extension, although the absence of perineural or lymphovascular invasion was a favorable factor. After 15 months of therapy with Vismodegib, tumour volume appeared well-controlled clinically, and significant tumour reduction was observed on repeat imaging. However, left upper eyelid and superior nasal lesions were identified, and biopsies taken from these sites proved local recurrence of basal cell carcinoma at the advancing edge of the initial lesion.
Conclusion
This case highlights the multidisciplinary challenges in managing orbit-invasive basosquamous carcinoma. Despite the presence of several poor prognostic indicators, systemic therapy with Vismodegib led to substantial tumour regression, resulting in improved local control and delayed recurrence. The patient remains under indefinite surveillance, with radiotherapy for biopsy-proven local recurrence while continuing Vismodegib, highlighting the need for long-term multimodal care.
Additional Authors
| First name | Last name | Base Hospital / Institution |
|---|---|---|
| Jwu Jin | Khong | Ophthalmology Department of Austin Health, Melbourne Australia |
