Orbitomalar Erosive Basal Cell Carcinoma.

Abstract

A 75-year-old Caucasian, immune-competent, and otherwise healthy male presented to the emergency department after a syncopal episode. He had a secondary complaint of left facial disfigurement and OS vision loss over the past few years. He reported this began as small “red nasal growth” 5 years ago. The lesion progressively grew and then became erosive; despite significant facial destruction, he did not seek medical care because of personal reasons. On exam, best corrected visual acuity was 20/40 in the OD and light perception in the OS. The right pupil and extraocular movements were within normal limits. He had left cicatricial hypotropia with diffusely restricted extraocular motility. Exam demonstrated erosion and absence of left midfacial soft tissues and bone including the orbital floor and anterior nasomaxillary area. The cornea was opaque with a chronic ulcer with temporal scleral thinning and uveal exposure (Fig. 1 and 2). Written consent was obtained for photography.FIG. 1.: External photograph demonstrating erosive changes of the orbit, maxillary sinus, nose, and face secondary to basal cell carcinoma.FIG. 2.: External photograph demonstrating corneal opacification, temporal scleral thinning and uveal exposure of the globe secondary to erosive basal cell carcinoma of the face.His syncopal episode was determined to be due to bacterial sepsis secondary to the facial infection. Pseudomonas aeruginosa and methicillin sensitive Staphylococcus aureus were isolated on facial wound culture. Treatment with broad spectrum antibiotics was initiated. Biopsies revealed ulcerated basal cell carcinoma (nodular type). CT imaging revealed no metastatic disease. Medical oncologic management was recommended for this nonresectable, advanced, facial-erosive disease. Eye removal surgery is contemplated for infectious disease control, but he currently has no significant pain. This case demonstrates the devastating oculofacial effects of neglected basal cell carcinoma.