Diffuse infiltrative basal cell carcinoma of the eyelid in an adolescent; a rare entity and its atypical presentation

Basal cell carcinoma (BCC) is the most common malignancy of the eyelids in the West; however, BCC is less common among Asians (11%–65%). Although it is prevalence among the elderly, it is rare in adolescents. Herein, we report a case of a 17-year-old boy who presented with a diffuse, irregular mass on the right lower eyelid, persisting for one year, with no associated ocular complaints. Further clinical evaluation revealed a diffuse, infiltrating lesion involving the lower lid and palpebral conjunctiva, an inflamed ocular surface, and a pigmented lesion along the lateral border of the lower eyelid, accompanied by the loss of lid architecture and cilia. The lesion was associated with symblepharon medially and fixation to the underlying tissue. Systemic examination was clinically unremarkable. An incision biopsy confirmed the diagnosis of basal cell carcinoma. The lesion was further managed by excision biopsy with a 4 mm margin, which revealed conjunctival extension on histopathological examination. A tumor-free margin was obtained after a deep excision, followed by further histopathological analysis. The defect was covered with an amniotic membrane graft, and no signs of recurrence were noted after an 8-month follow-up.