Case Report: Periocular Malignant Neoplasm

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Unreparable DNA damage may also araise. Thus, uncontrolled tumor proliferation may occur. Surgical excision remains a treatment associated with adjuvant management. Observation A 57-year male presented with optic correction. He was classified as skin prototype III. An ophthalmological examination revealed an ulcerative lower eyelid lesion. He underwent a biopsy with histological analysis confirmed the presence of malignant basaloid tumor cells. Complete excision was performed with 3 mm surgical margins and associated with radiotherapy. The follow-up was marked by good oncological and aesthetic results. Conclusion The periocular skin area is the most common site of malignant lesions in the head and neck. Locoregional extension and metastasis remain deadly complications. Early diagnosis is essential. Therefore, any periocular skin lesion should be considered, and biopsy should be performed at the slightest doubt. 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Manager Bibtex ProCite Sente EXPORT Select a format first Track Share ▬ ✚ Case Report Case Report: Periocular Malignant Neoplasm [version 1; peer review: awaiting peer review] Asma Zaghdoudi https://orcid.org/0000-0002-2075-1050 1 , Olfa Blel 1 , Mohamed Habib Hedhiri 1 , [...] Nada Sakli 1 , Sameh Mbarek 1 , leila belaid 2 , Wafa Ammari https://orcid.org/0000-0002-1041-7171 1 , Anis Mahmoud https://orcid.org/0000-0001-5424-3081 1 , Riadh Messaoud 1 Asma Zaghdoudi https://orcid.org/0000-0002-2075-1050 1 , Olfa Blel 1 , [...] Mohamed Habib Hedhiri 1 , Nada Sakli 1 , Sameh Mbarek 1 , leila belaid 2 , Wafa Ammari https://orcid.org/0000-0002-1041-7171 1 , Anis Mahmoud https://orcid.org/0000-0001-5424-3081 1 , Riadh Messaoud 1 PUBLISHED 07 Jul 2025 Author details Author details 1 Ophthalmology, Tahar Sfar Hospital, Mahdia, Tunisia 2 Anatomical pathology, Tahar Sfar Hospital, Mahdia, Tunisia Asma Zaghdoudi Roles: Conceptualization, Data Curation, Funding Acquisition, Investigation, Methodology, Project Administration, Resources, Supervision, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Olfa Blel Roles: Investigation, Resources Mohamed Habib Hedhiri Roles: Writing – Review & Editing Nada Sakli Roles: Resources Sameh Mbarek Roles: Writing – Review & Editing leila belaid Roles: Resources Wafa Ammari Roles: Resources Anis Mahmoud Roles: Resources Riadh Messaoud Roles: Writing – Review & Editing OPEN PEER REVIEW REVIEWER STATUS AWAITING PEER REVIEW This article is included in the Eye Health gateway. Abstract Introduction Periocular tissues are exposed to sunlight ultraviolet rays. Unreparable DNA damage may also araise. Thus, uncontrolled tumor proliferation may occur. Surgical excision remains a treatment associated with adjuvant management. Observation A 57-year male presented with optic correction. He was classified as skin prototype III. An ophthalmological examination revealed an ulcerative lower eyelid lesion. He underwent a biopsy with histological analysis confirmed the presence of malignant basaloid tumor cells. Complete excision was performed with 3 mm surgical margins and associated with radiotherapy. The follow-up was marked by good oncological and aesthetic results. Conclusion The periocular skin area is the most common site of malignant lesions in the head and neck. Locoregional extension and metastasis remain deadly complications. Early diagnosis is essential. Therefore, any periocular skin lesion should be considered, and biopsy should be performed at the slightest doubt. READ ALL READ LESS Keywords Basal cell, Carcinoma, Case report, Eyelids Corresponding Author(s) Asma Zaghdoudi ( [email protected] ) Close Corresponding author: Asma Zaghdoudi Competing interests: No competing interests were disclosed. Grant information: The author(s) declared that no grants were involved in supporting this work. Copyright: © 2025 Zaghdoudi A et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How to cite: Zaghdoudi A, Blel O, Hedhiri MH et al. Case Report: Periocular Malignant Neoplasm [version 1; peer review: awaiting peer review] . F1000Research 2025, 14 :666 ( https://doi.org/10.12688/f1000research.164464.1 ) First published: 07 Jul 2025, 14 :666 ( https://doi.org/10.12688/f1000research.164464.1 ) Latest published: 07 Jul 2025, 14 :666 ( https://doi.org/10.12688/f1000research.164464.1 ) Introduction Malignant lesions are approximately 13.1% of eyelid tumors. 1 Basal cell carcinoma (BCC) is the most common type of cancer. 2 Risk factors, such as exposure to UV light, were identified. It is the main contributor to the development of these malignant lesions. 1 , 2 Intracranial extension requires efficient emergency treatment with safe margin surgical excision. 3 We present the case of a patient with primary lower eyelid basocell carcinoma discovered during routine examination. Patient information A 57-year male, presented to the ophthalmology department with optical correction. He had no medical history and skin prototype III. The patient was a farmer with chronic sun exposure. Clinical findings Ophthalmological examination of the right eye revealed an ulcerative budding lower eyelid lesion measuring 1*0.5 centimeter, with some telangiectasia and pigmentation ( Figure 1 ). Figure 1. Photography of right eye showing ulcerative-budding lower eyelid lesion measuring 1*0.5 centimeter, with some telangiectasia and pigmentation in places. It was indurated on palpation and fixed to deeper tissues. The remaining ophthalmological examinations showed no abnormalities. The patient reported that it had evolved over 3 months and was painless. No history of trauma was found. Diagnostic assessment The patient underwent biopsy of the lesion. Histological examination revealed malignant epithelial proliferation consisting of solid cell masses bordered by malignant basaloid tumor cells, confirming the diagnosis of basal cell carcinoma. The stroma is dotted with inflammatory cells containing melanin deposits ( Figure 2 ). Figure 2. Photography of histological section, hematoxylin and eosin stain, showing malignant epithelial proliferation bordered by malignant basaloid tumor cells. Therapeutic intervention The diagnosis of basal cell carcinoma was made. The treatment consisted of surgical excision, with 3 mm surgical margins associated with local radiotherapy. Follow-up and outcomes The follow up is marked by a good oncological and aesthetic result. Discussion This case highlights the importance of careful ophthalmological examination of all ocular structures during routine examination. Any suspicious eyelid lesions must be explored to ensure optimal and early care. Eyelids are common sites of UV radiation lesions. 1 It represents the site of 5-10% of all skin cancers. 4 Basal cell carcinoma is caused by UV DNA damage with mutations in the PTCH1 gene, which leads to the uncontrolled growth of malignant cells. 1 However, 29% of malignant lesions were considered benign clinically. 3 There are two histological types, nodular and sclerotic. 4 The lower eyelid is typically the site. The upper eyelid can mimick blepharitis. 5 Local surgical excision remains the gold standard treatment, with 3 to 4 mm surgical margins followed by repair of the resulting defect. 1 Reconstruction of the lower eyelid is a significant challenge, and several techniques have been proposed. 6 One-step and two-step surgeries demonstrated similar results. 7 The recurrence rate is approximately 5% per year. 4 Therefore, adjuvant treatments such as radiotherapy and brachytherapy achieve local control and good cosmetic outcomes. 8 Adjunctive hyperbaric oxygen therapy is also beneficial for increasing wound healing. 9 Therefore, patients must be educated to prevent skin tumors. Sun protection and nicotine avoidance are two modifiable risk factors. 1 Conclusion Public education on the appearance of abnormal skin lesions is crucial. Management of these lesions is multidisciplinary. Early detection is the primary method for improving the prognosis and quality of life of patients. Patient perspective I experienced rescue of my life which was in danger. This neglected meniscus lesion could have a significant impact on visual and vital prognosis. My anxiety is reduced with good outcomes after excision. Patient consent The authors declare no conflicts of interest. Written consent was obtained from the patient for the publication of this case report. The patient signed an informed consent for the publication. Data availability No data are associated with this article. Reporting guidelines Care Checklist “Case Report: Periocular Malignant Neoplasm, olfa-blel-my-research-cbf14f8”, https://doi.org/10.5281/zenodo.15742016 . 10 Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0). Acknowledgment This case report was prepared according to the CARE Guidelines for Case Reports: explanation and elaboration of documents. David S. Riley et al., published in the Journal of Clinical Epidemiology 89 (2017):218-35. References 1. Rana H, Stokkermans TJ, Purt B, et al. : Malignant Eyelid Lesions. 2023 Aug 14. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2025 Jan. 2. Mukarram M, Khachemoune A: Upper and Lower Eyelid Malignancies: Differences in Clinical Presentation, Metastasis, and Treatment. Arch. Dermatol. Res. 2024 Jun 22; 316 (7): 429. PubMed Abstract | Publisher Full Text 3. Roque-Choque EC, Villalobos-Espinoza JR, Silva-Ocas I, et al. : Primary basal cell carcinoma of the caruncle: case report and review of the literature. Arq. Bras. Oftalmol. 2024 Mar 22; 87 (3): e20220357. PubMed Abstract | Publisher Full Text 4. Told R, Reumueller A, Kreminger J, et al. : Long-term results after surgical basal cell carcinoma excision in the eyelid region: revisited. Wien. Klin. Wochenschr. 2025 Jan; 137 (1-2): 7–12. PubMed Abstract | Publisher Full Text | Free Full Text 5. Mariños AP, Valverde-López J, Cárdenas CP: Superficial basal cell carcinoma masquerading as pruritic dermatitis on the upper eyelid. Acta Dermatovenerol. Alp. Pannonica Adriat. 2025 Jan 13; 34 (1): actaapa.2025.1. Publisher Full Text 6. Mitra S, Panda S, Singh CA, et al. : Modified Mustardé Flap for Lower Eyelid Reconstruction in Basal Cell Carcinoma: Revisited. Indian J. Otolaryngol. Head Neck Surg. 2023 Sep; 75 (3): 2492–2495. PubMed Abstract | Publisher Full Text | Free Full Text 7. Unlu M, Ozer F, Vural A: A comparison of two surgical techniques for basal cell carcinoma of the eyelid: two-step surgery and one-step surgery. Int. Ophthalmol. 2024 Dec 10; 45 (1): 6. PubMed Abstract | Publisher Full Text 8. Oliveira CN, Viveiros C, Travancinha C, et al. : Treatment of Basal Cell Carcinoma of the Lower Eyelid With High-Dose-Rate Brachytherapy. Cureus. 2024 Jan 27; 16 (1): e53067. PubMed Abstract | Publisher Full Text 9. Oley MH, Oley MC, Gunawan DF, et al. : Adjunctive hyperbaric oxygen therapy with reconstruction of lower eyelid for basal cell carcinoma: A case series. Int. J. Surg. Case Rep. 2023 Feb; 103 : 107890. PubMed Abstract | Publisher Full Text | Free Full Text 10. Blel O: olfa-blel-my-research-cbf14f8. Reference Source Comments on this article Comments (0) Version 1 VERSION 1 PUBLISHED 07 Jul 2025 ADD YOUR COMMENT Comment Author details Author details 1 Ophthalmology, Tahar Sfar Hospital, Mahdia, Tunisia 2 Anatomical pathology, Tahar Sfar Hospital, Mahdia, Tunisia Asma Zaghdoudi Roles: Conceptualization, Data Curation, Funding Acquisition, Investigation, Methodology, Project Administration, Resources, Supervision, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Olfa Blel Roles: Investigation, Resources Mohamed Habib Hedhiri Roles: Writing – Review & Editing Nada Sakli Roles: Resources Sameh Mbarek Roles: Writing – Review & Editing leila belaid Roles: Resources Wafa Ammari Roles: Resources Anis Mahmoud Roles: Resources Riadh Messaoud Roles: Writing – Review & Editing Competing interests No competing interests were disclosed. Grant information The author(s) declared that no grants were involved in supporting this work. Article Versions (1) version 1 Published: 07 Jul 2025, 14:666 https://doi.org/10.12688/f1000research.164464.1 Copyright © 2025 Zaghdoudi A et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Download Export To Sciwheel Bibtex EndNote ProCite Ref. Manager (RIS) Sente metrics Views Downloads F1000Research - - PubMed Central info_outline Data from PMC are received and updated monthly. - - Citations open_in_new 0 open_in_new 0 open_in_new SEE MORE DETAILS CITE how to cite this article Zaghdoudi A, Blel O, Hedhiri MH et al. Case Report: Periocular Malignant Neoplasm [version 1; peer review: awaiting peer review] . F1000Research 2025, 14 :666 ( https://doi.org/10.12688/f1000research.164464.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS track receive updates on this article Track an article to receive email alerts on any updates to this article. TRACK THIS ARTICLE Share Open Peer Review Current Reviewer Status: AWAITING PEER REVIEW AWAITING PEER REVIEW ? Key to Reviewer Statuses VIEW HIDE Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. 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