Basal cell carcinoma involving the lacrimal canaliculus: A documented mechanism of tumor spread

BACKGROUND. Basal cell carcinoma (BCC) is the most common malignant tumor of the eyelid and periocular tissues but rarely involves the lacrimal system. In addition, BCC in this location frequently recur due to inadequate margin control. A further understanding of the pathophysiology of periocular BCC was addressed. OBJECTIVE. To report two rare cases of BCC involving the lacrimal system and to account for subtle clinical features yet extensive tissue spread of periocular BCC. METHODS. Using the Mohs micrographic surgical technique, we describe two patients with a BCC involving the lacrimal system that histologically tracked beyond clinically apparent margins. RESULTS. Spread of BCC along mucosal surfaces is documented. CONCLUSION. Rare involvement of the lacrimal system by a BCC is reported in two patients. Superficial histologic involvement can explain the ability of BCC to extend locally and escape adequate treatment.