Recurrent Locally Advance Morpheaform BCC

A patient presented to our clinic with a 5 month history of worsening ptosis and induration of the right upper eyelid. She had a past medical history significant for chronic UV exposure, and a previously completely excised infiltrating/morpheaform basal cell carcinoma years prior in the same location . Examination corroborated an indurated right upper eyelid mass causing mechanical ptosis with contraction of the previous incision site. Outside biopsy confirmed a diagnosis of recurrent morpheaform basal cell carcinoma. The patient was sent for Mohs surgery with planned sequential reconstruction. Clear margins were not obtained through Mohs surgery. Intraoperatively frozen sections were taken before reconstruction. Frozen sections remained positive within the deep orbit, lateral margin and semilunar fold. This confirmed a diagnosis of locally advanced BCC with extension to the anterior orbit. After careful consideration and following a globe sparing surgery to avoid further morbidity, reconstruction of the upper eyelid was completed with a free tarsal graft and inner brachial skin graft. Further studies demonstrated minimal extension to the anterior orbit with no metastasis, the patient achieved a good cosmetic and functional result and is currently on surveillance receiving a combination for radiotherapy and hedgehog inhibitors daily.

Presentation Date: 05/16/2024

Issue Date: 05/24/2024