Periocular basal cell carcinoma: A comprehensive narrative review on pathogenesis, diagnosis, and management

Basal cell carcinoma (BCC) is the most common malignancy affecting the eyelid and periocular region, comprising over 80% of all eyelid tumors.While BCC rarely metastasizes, its potential for local invasion into critical ocular structures can result in significant morbidity, including vision loss, disfigurement, and functional impairment.Given the anatomical complexity of the periocular area, early diagnosis and precise intervention are essential.This narrative review aims to provide a comprehensive and ophthalmology-specific overview of periocular BCC, encompassing its epidemiology, pathogenesis, histopathology, diagnostic strategies, and management options.The review also highlights current challenges and proposes future directions in improving care for this increasingly common malignancy.A literature search was conducted using PubMed, Scopus, and Google Scholar for English-language articles published between January 2010 and April 2024.Keywords included "basal cell carcinoma," "eyelid tumor," "periocular BCC," "Mohs surgery," "Hedgehog pathway," and "vismodegib."Approximately 80 peer-reviewed articles were included based on clinical and scientific relevance.Nodular BCC is the most prevalent histological subtype in the periocular region, followed by infiltrative and morpheaform types, which have higher recurrence risks.Diagnosis is often delayed due to resemblance to benign lesions.Mohs micrographic surgery offers >99% cure rates for high-risk cases.For advanced or unresectable cases, systemic therapies such as Hedgehog pathway inhibitors and immunotherapy provide emerging treatment options.Periocular BCC exemplifies a low-mortality but high-morbidity malignancy where early detection, multidisciplinary collaboration, and subtype-specific management can significantly impact visual outcomes and quality of life.Future efforts should focus on diagnostic innovation, outcome measurement, and global awareness.