Clinical History:

A 62-year-old man resides in the Sunshine State (Trinity Beach, Queensland or Daytona Beach, Florida). He has noted the increasing size of a nodule on his lower eyelid for the past 4 years. His vision is not affected, but the nodule becomes irritated when scratched. He now comes to you for advice regarding this lesion.

Gross and Microscopic Pathology:

The basal cell carcinoma seen here is a nodular lesion of the lower eyelid that has a slightly raised pearly border and a central ulceration. Microscopically, the lesion is composed of nests of small dark blue cells resembling the basal cells of the epidermis. These nests invade into the dermis.

Questions:

1. What is the name for this mass lesion?

This is a basal cell carcinoma, one of the most common skin malignancies.

2. How does this lesion occur and how can it be prevented?

A basal cell carcinoma is one form of skin cancer that is related to sun exposure (ultraviolet light). These lesions are common about the face, shoulders, and upper chest. Protection from the sun (sunscreen, hat) constitutes prevention. The population in either Sunshine State is composed predominantly of fair-skinned persons of European ancestry with greater risk.

3. What is the prognosis with treatment?

The treatment is surgical. The larger the lesion, the harder it is to excise the lesion and leave residual tissue to maintain eyelid function. At the time of surgery, frozen section examination of the excised tissue can help to determine how far to extend the excision and still have margins clear of tumor. Basal cell carcinomas almost never metastasize, but they will continue to grow locally if not completely excised.