Surgical Management of Giant Basal Cell Carcinoma of the Upper Eyelid: A Case Report

Basal cell carcinoma is the most common malignant tumor of the eyelid and, although typically slow growing, can become locally aggressive and disfiguring when diagnosis or treatment is delayed. We report a rare case of a giant, long-standing basal cell carcinoma of the upper eyelid in a 62-year-old female who presented with a 30-year history of a progressively enlarging pigmented ulcerative lesion associated with mechanical ptosis. Clinical examination revealed a large indurated ulcer with rolled margins involving the upper eyelid and eyebrow region, with no regional lymphadenopathy. Excisional biopsy followed by histopathological evaluation confirmed an infiltrative variant of basal cell carcinoma. The patient underwent wide local excision with adequate safety margins and immediate reconstruction using a forehead axial flap, with the donor site covered by a split-thickness skin graft. Postoperative recovery was uneventful, with good graft uptake and satisfactory functional and cosmetic outcomes at follow-up. This case highlights the potential for basal cell carcinoma to attain giant proportions when neglected, underscores the importance of histopathological confirmation and margin-controlled excision, and demonstrates that even extensive periocular tumors can be successfully managed with appropriate surgical planning and multidisciplinary reconstruction.