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 Table of Contents  
SURGICAL CORNER
Year : 2021  |  Volume : 33  |  Issue : 1  |  Page : 67-70

Basaloid squamous cell carcinoma of eyelid: A rare presentation in rural India


Department of Ophthalmology, Rural Medical College, Pravara Institute of Medical Sciences, Loni, Maharashtra, India

Date of Submission23-Sep-2020
Date of Decision05-Dec-2020
Date of Acceptance07-Dec-2020
Date of Web Publication19-Apr-2021

Correspondence Address:
Dr. Priyanka Dileep Asgaonkar
Department of Ophthalmology, Rural Medical College, Pravara Institute of Medical Sciences, Loni Bk - 413 736, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/kjo.kjo_149_20

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  Abstract 


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 Top


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.[1],[2] 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.[2] 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 Top


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.
Figure 1: Left lower eyelid basaloid squamous cell carcinoma

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Surgical management

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].
Figure 2: Histopathology of basaloid squamous cell carcinoma

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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 4: Immediate postoperative picture

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Figure 5: (a) Postoperative picture after 1 year. (b) Postoperative picture after 1 year

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  Discussion Top


BSCC affects usually the older age groups mainly individuals from 60 to 70 years. The disease affects men more than the females.[2] 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.[3] It is shown to have an association with chronic alcohol and tobacco addiction.[2],[3] 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.[4] 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[5] restoration of eyelid anatomy and function and preventing further spread of the lesion is the main concern of eyelid reconstruction.[6] Performing eyelid reconstruction can be a difficult task as any improper reapproximation can be compromising to the eyelid function and visual function.[7] Utilization of local flaps for lower lid reconstruction has been considered as a gold standard.[8] Skin grafts, free flaps, locoregional flaps, and local flaps are some of the local techniques used for reconstruction.[9] There are various methods for lower eyelid reconstruction described by Barba-Gómez et al.[10] Mustarde and the Hughes transposition flap with its modification[11] (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 Top


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

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Wain SL, Kier R, Vollmer RT. Basaloid-squamous carcinoma of the tongue hypopharynx and larynx: Report of 10 cases. Hum Pathol 1986;17:1158-66.  Back to cited text no. 1
    
2.
Oikawa K, Tabuchi K, Nomura M. Basaloid squamous cell carcinoma of the maxillary sinus: A report of two cases of the head and neck. Auris Nasus Larynx 2007;34:119-23.  Back to cited text no. 2
    
3.
Soriano E, Faure C, Lantuejoul S, Reyt E, Bolla M, Brambilla E, et al. Course and prognosis of basaloid squamous cell carcinoma of the head and neck: A case-control study of 62 patients. Eur J Cancer 2008;44:244-50.  Back to cited text no. 3
    
4.
Wieneke JA, Thompson LD, Wenig BM. Basaloid squamous cell carcinoma of the sinonasal tract. Cancer 1999;85:841-54.  Back to cited text no. 4
    
5.
Mustarde JC. Repair and Reconstruction in Orbital Region. 2nd ed.. Philadelphia: Churchill Livingstone; 1991.  Back to cited text no. 5
    
6.
Subramanian N. Reconstruction of eyelid defects. Indian J Plast Surg 2011;44:5-13.  Back to cited text no. 6
[PUBMED]  [Full text]  
7.
Chang E. Eyelid reconstruction. In: Buchen D, editor. Skin Flaps in Facial Surgery. USA, New York: McGraw-Hill; 2006.  Back to cited text no. 7
    
8.
Fogagnolo P, Colletti G, Valassina D, Allevi F, Rossetti L. Partial and total lower lid construction; Our experience with 41 cases. Ophthalmologica 2012;228:239-43.  Back to cited text no. 8
    
9.
Raschke GF, Rieger UM, Bader RD, Schäfer O, Schultze-Mosgau S. Objective anthropometric analysis of eyelid reconstruction procedures. J Craniomaxillofac Surg 2013;41:52-8.  Back to cited text no. 9
    
10.
Barba-Gómez J, Zuñiga-Mendoza O, Iñiguez-Briseño I, Sánchez-Tadeo MT, Barba-Gómez JF, Molina-Frechero N, et al. Total lower-eyelid reconstruction: Modified Fricke's cheek flap. J Plast Reconstr Aesthet Surg 2011;64:1430-5.  Back to cited text no. 10
    
11.
Hughes WL. Total lower eyelid reconstruction: Technical details. Trans Am Ophthalmol Soc 1976;74:321-9.  Back to cited text no. 11
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]



 

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