Basal Cell Carcinoma: Essential Guide for Optometrists

Index

Basal Cell Carcinoma: Essential Guide for Optometrists

Basal Cell Carcinoma (BCC) is the most common type of skin cancer and the most frequent malignant tumor of the eyelid. Though BCC rarely metastasizes, it can cause significant local tissue destruction, including invasion of ocular structures. Early identification by optometrists is crucial to prevent vision loss and disfigurement.

Common Sites of BCC in the Ocular Region

Lower eyelid (most common, ~50-60% of cases) Medial canthus Upper eyelid Lateral canthus

Clinical Features of BCC

Feature	Description
Appearance	Pearly, translucent nodule with rolled edges
Surface Features	Telangiectatic vessels, possible ulceration
Growth Pattern	Slow-growing but locally invasive
Symptoms	Often asymptomatic; later stages may cause irritation, bleeding, or vision changes
Advanced Features	Central ulceration (rodent ulcer), lash loss, distortion of eyelid margin

Symptoms

Often asymptomatic; later stages may cause irritation, bleeding, or vision changes

Advanced Features

Central ulceration (rodent ulcer), lash loss, distortion of eyelid margin

Risk Factors

Chronic sun exposure (UV radiation) Fair skin and light-colored eyes Older age Personal or family history of skin cancers Immunosuppression History of radiation exposure

Optometric Management

1. Assessment

Perform a detailed external examination of periocular skin. Use slit-lamp magnification to assess lesion edges, surface, and vascularity. Look for associated signs: madarosis (lash loss), lid notching, or ulceration.

2. Documentation

Capture high-quality external photographs at baseline. Document lesion size, location, texture, and any changes over time.

3. Referral Guidelines

Urgent Referral to oculoplastics or dermatology if: Suspicious appearance (pearly nodule, telangiectasia, ulceration) Progressive growth Eyelid margin distortion Lash loss

BCC is confirmed through biopsy, with treatment often involving surgical excision (Mohs micrographic surgery preferred).

Role of Optometrists After Referral

Monitor for recurrence during routine eye exams. Educate patients on UV protection (wide-brim hats, UV-blocking sunglasses). Reinforce regular skin cancer screenings, especially in high-risk individuals.

Quick Reference Summary

✅ Suspect BCC with pearly nodules, telangiectasia, or ulceration

✅ Always document and photograph suspicious lesions

✅ Refer promptly to oculoplastics or dermatology

✅ Emphasize UV protection and follow-up care

Conclusion

Optometrists have a pivotal role in the early detection of basal cell carcinoma, especially in the periocular region. Recognizing typical features and knowing when to refer can prevent serious ocular complications and improve patient outcomes.