Radical Resection and Reconstruction of Recurrent Periocular Basal Cell Carcinoma Involving Orbit and Midface: A Multidisciplinary Case Report

Basal cell carcinoma (BCC) is a locally invasive skin malignancy that can affect the periocular region, often posing significant reconstructive challenges when recurrent or inadequately treated. We report the case of an 80-year-old male with a history of multiple facial BCC excisions who presented with progressive left facial tissue loss and vision loss. Biopsy confirmed recurrent BCC, and positron emission tomography computed tomography (PET-CT) revealed a hypermetabolic mass involving the left orbit, zygoma, and maxillary sinus without distant metastasis. The patient underwent radical oncologic resection, including orbital exenteration, maxillectomy, lateral rhinotomy, ethmoidectomy, and resection of the zygoma and pterygopalatine fossa. Reconstruction involved a split calvarial bone graft for skeletal support and a radial forearm free flap for soft tissue coverage. Pathology showed a 4.7 cm tumor with invasion into conjunctiva, muscle, and bone, and involvement of the deep margin. He recovered well, received adjuvant radiation therapy, and later underwent revision surgery for hardware exposure, with no malignancy identified on pathology. This case illustrates the importance of a multidisciplinary approach and long-term follow-up in managing complex, recurrent periocular BCC to optimize oncologic control and reconstructive outcomes.