This is the most common malignant tumour of the eyelid in adults (80-90% of cases). Patho-
genesis is related to exposure to ultraviolet light, hence it most frequently involves the lower lid and medial canthus. The tumour begins as a small insignificant nodule, which turns into a small crater-like lesion with a slightly raised, pearly-coloured edge with fine dilated blood vessels on its surface (Figure 15.6). Although the tumour rarely metastasises, it is locally invasive, and, therefore, early diagnosis and treatment is important. In the early stages, it is a simple matter to remove the lesion and confirm the diagnosis by biopsy, but if left the tumour tends to spread into surrounding structures and into the underlying bone and orbit (Figure 15.7). Treatment depends on the size, extent and location of the tumour. Usually, surgical excision with wide margins is the technique of choice, either by a simple excisional biopsy or by the more complex Mohs' procedure. The more extensive, neglected basal cell carcinomata are treated by radical surgery, cryotherapy or palliative radiotherapy.
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