|Year : 2021 | Volume
| Issue : 1 | Page : 67-70
Basaloid squamous cell carcinoma of eyelid: A rare presentation in rural India
Priyanka Dileep Asgaonkar, Gauri Badhe Bankar, Akshita Sharma, Kishor P Badhe
Department of Ophthalmology, Rural Medical College, Pravara Institute of Medical Sciences, Loni, Maharashtra, India
|Date of Submission||23-Sep-2020|
|Date of Decision||05-Dec-2020|
|Date of Acceptance||07-Dec-2020|
|Date of Web Publication||19-Apr-2021|
Dr. Priyanka Dileep Asgaonkar
Department of Ophthalmology, Rural Medical College, Pravara Institute of Medical Sciences, Loni Bk - 413 736, Maharashtra
Source of Support: None, Conflict of Interest: None
Basaloid squamous cell carcinoma (BSCC) is an aggressive rare sub-variant of squamous cell carcinoma that usually affects the upper aerodigestive tract. Ophthalmic presentation of this variety is rather rare. In our case report, we report a case of primary lower eyelid BSCC, which was treated successfully.
Keywords: Basaloid squamous cell carcinoma, eyelid malignancy, eyelid reconstruction, periocular malignancy
|How to cite this article:|
Asgaonkar PD, Bankar GB, Sharma A, Badhe KP. Basaloid squamous cell carcinoma of eyelid: A rare presentation in rural India. Kerala J Ophthalmol 2021;33:67-70
|How to cite this URL:|
Asgaonkar PD, Bankar GB, Sharma A, Badhe KP. Basaloid squamous cell carcinoma of eyelid: A rare presentation in rural India. Kerala J Ophthalmol [serial online] 2021 [cited 2021 Jun 13];33:67-70. Available from: http://www.kjophthal.com/text.asp?2021/33/1/67/314089
| Introduction|| |
Basaloid squamous cell carcinoma (BSCC) is a rare and an aggressive variant of squamous cell carcinoma as reported by Wain et al. in 1986. It has a predilection for the upper aerodigestive tract., The hallmark of basaloid cell carcinoma is nesting, lobular, and trabecular arrangement of small crowded cells with scanty cytoplasm with hyperchromatic nuclei, the malignant cells display peripheral nuclear palisading, high mitotic activity with comedo necrosis and small cystic spaces with mucinous material. Less commonly affected sites include nose, PNS, external ear, lungs, vulva, vagina, and uterine cervix. Ophthalmic presentation of this variant is extremely rare and by far only one case has been reported affecting the conjunctiva. We report a case of BSCC of the lower eyelid which to the best of our knowledge has not yet reported.
| Case Report|| |
A 66-year-old female came to the outpatient department with complaints of an ulcerative lesion on the left lower eyelid for 2 years which had gradually increased in size. There was no past history of any ocular trauma, any other debility or fever, addictions, or similar complaints in the family. General and systemic examination was within the normal limits. There were no palpable lymph nodes.
Her visual acuity was 6/36 in the right eye and 6/24 in the left eye with immature senile cataract. On local examination, the lesion was on the left lower eyelid extending from the mid to lateral eyelid measuring about 2 cm × 1.5 cm. It was an ulcerative lesion with an irregular surface and margins [Figure 1], firm consistency, nonpulsatile, and noncompressible. The patient did not complain of pain; however, on palpation, there was mild tenderness. Transillumination was negative, and there was no bruit, with no lymphadenopathy. The rest of the anterior segment was within the normal limits. Fundus examination was within the normal limits. The routine blood investigations showed leukopenia; rest blood investigations were within the normal limits; the chest X-ray was normal. A positron emission tomography (PET) and chest computed tomography (CT) scan could not be performed due to financial constraints.
An incisional biopsy was performed under local anesthesia. The histological examination showed a tumor composed of polygonal cells with hyperchromatic, pleomorphic nuclei, and scanty cytoplasm separated with fibrous septae with inflammatory cells. There was peripheral palisading pattern of tumor cells. Thus, the histopathological diagnosis was BSCC [Figure 2].
The patient underwent full-thickness excision of the lower lid lesion with clear margins of 3 mm under local anesthesia [Figure 3]a. Margin clearance was confirmed by intraoperative frozen section of the margins of the excised tissue. A perichondrium graft was procured from the back of the left ear of the patient, and a skin graft was taken from the upper left eyelid and grafted over the left lower eyelid [Figure 3]b,[Figure 3]c,[Figure 3]c,[Figure 3]d,[Figure 3]e,[Figure 3]f. The grafts were sutured with mersilk 6-0 suture material [Figure 4]. The patient was further referred to our oncology department for further management where she received radiotherapy. The patient was observed for a period of 1 year [Figure 5]. The end cosmetic results were satisfactory, and the lesion has not recurred since then.
|Figure 3: (a) Excision of the lower eyelid lesion. (b) Perichondrial graft procured from the back of the ear. (c) Perichondial graft. (d) Perichondrial graft placement and suturing to lower eyelid excised area. (e) Skin graft from the upper eyelid sutured to the lower eyelid excised area over perichondrial graft. (f) Final picture after completion of suturing|
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|Figure 5: (a) Postoperative picture after 1 year. (b) Postoperative picture after 1 year|
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| Discussion|| |
BSCC affects usually the older age groups mainly individuals from 60 to 70 years. The disease affects men more than the females. It is an aggressive variant of the squamous cell carcinoma which has six times higher risk of distant metastasis and lymph nodal involvement than the former as described by Soriano et al.; therefore, a CT chest and PET scan is usually advised to rule out distant metastasis. It is shown to have an association with chronic alcohol and tobacco addiction., The most common sites of affection of this rare variant include the base of the tongue, larynx, and hypopharynx. It usually presents as either an obstructive mass or pain. According to the study conducted by Wieneke et al., BSCC demonstrated surface dysplasia with no evidence of multifocal disease. In our case, the patient was a female with no addictions, no evidence of pain, and lymphadenopathy with a slow-growing lesion which simulated a basal cell carcinoma. However, the typical histopathological picture labeled it as BSCC.
The eyelid reconstruction is based on the following three main principles: an outer layer of skin, inner layer of mucosa, and a semirigid skeleton interposed between them restoration of eyelid anatomy and function and preventing further spread of the lesion is the main concern of eyelid reconstruction. Performing eyelid reconstruction can be a difficult task as any improper reapproximation can be compromising to the eyelid function and visual function. Utilization of local flaps for lower lid reconstruction has been considered as a gold standard. Skin grafts, free flaps, locoregional flaps, and local flaps are some of the local techniques used for reconstruction. There are various methods for lower eyelid reconstruction described by Barba-Gómez et al. Mustarde and the Hughes transposition flap with its modification (4 from NCBI). In our case, we performed a reconstruction of the lower eyelid after complete lesion excision using a perichondrial graft from ear and skin graft from the upper eyelid.
| Conclusion|| |
BSCC of the lower eyelid is an extremely rare entity as it mainly affects the aero-digestive tract. Proper clinical and histopathological examination can help in the diagnosis. Eyelid reconstruction becomes a very important line of treatment to maintain the integrity of eyelid anatomy and function and prevent further progression the disease.
Declaration of patient consent
The authors certify that they have obtained patient consent form. In the form, the patient has given her consent for her images and other information to be published in the journal. The patient understands that their names and initials will not be disclosed and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]