Basal Cell Carcinoma

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Clinical Presentation

  • Lower eyelid most commonly affected, followed by the medial canthus
  • Slow-growing, locally destructive
  • Nodular skin changes, flesh-coloured thickening
  • Pearly nodule with telangiectasias
  • Ulceration, crust formation, may bleed
  • Changes in eyelid architecture? Madarosis (loss of eyelashes)?
  • Morpheaform subtype with white- /flesh-coloured area of induration and ill-defined borders


  • Photodocumentation
  • Consider biopsy (depending on lesion)


  • Complete surgical excision with margin control
  • In specific cases, medicinal treatment possible (topical Imiquimod 5%, Vismodegib)

Follow-up after excision of a basal cell carcinoma

  • Every 3 months in the 1st year
  • every 6 months in the 2nd year
  • If no new basal cell carcinoma or recurrence for more than 2 years: annual follow-up for 5 years
  • Individually more often
  • Educate about sun protection and self-monitoring


  • AWMF Guidelines Basalzellkarzinom (German)
  • EyeWiki Basal Cell Carcinoma
  • The Wills Eye Manual: Office and Emergency Room Diagnosis and Treatment of Eye Disease; Nika Bagheri MD, Brynn Wajda MD, et al; Lippincott Williams&Wilkins; 7th Edition (2016)
  • Kanski’s Clinical Ophthalmology: A Systematic Approach; Jack J. Kanski MD, Brad Bowling MD; Saunders Ltd.; 8th Edition (2015)