Combined surgical excision with open wound healing and photodynamic therapy for periocular basal cell carcinoma: A case report

Abstract

This study evaluated a combined approach of surgical excision with open wound healing and photodynamic therapy (PDT) for periocular basal cell carcinoma (BCC) in a 72-year-old male patient, whose lesion involved a high-risk anatomical location due to direct proximity to ocular structures. The patient presented with a 7-year history of progressive periocular BCC involving the medial canthus and nasal root. Given the lesion’s proximity to ocular structures, a staged protocol was implemented with three preoperative PDT sessions administered weekly to reduce tumor burden. Gross tumor resection with 1–2 mm margins was then performed, leaving the wound to heal by secondary intention. Immediate postoperative PDT was followed by a second PDT cycle of three weekly sessions. Preoperative PDT achieved significant tumor regression. Surgical excision proceeded with minimal tissue loss. Subsequent histopathology of the specimen revealed positive peripheral margins, retrospectively validating the necessity of the PDT for treating residual disease. No recurrence was observed over a 5-year follow-up, and the healed scar was flat, pliable, and caused no functional or significant cosmetic concern to the patient. The combined approach preserved anatomical integrity and function while avoiding extensive reconstructive surgery risks. It offers a viable alternative to radical excision, balancing oncologic outcomes with functional and cosmetic preservation. Further studies are warranted to optimize protocols for similar anatomically challenging cases.