# Surgical management of periocular squamous cell carcinoma: case report

## TL;DR

A 72-year-old woman with a squamous cell carcinoma on her eyelid required multiple surgeries to fully remove the tumor and ensure safe margins.

## Contribution

This case highlights the challenges and surgical approach for eyelid squamous cell carcinoma with anticoagulant use.

## Key findings

- The tumor was initially excised but required an additional 3 mm removal due to incomplete margins.
- Anticoagulant use increased surgical bleeding, complicating the procedure.
- Reconstruction with advancement flaps achieved functional and aesthetic outcomes after complete excision.

## Abstract

This report describes the case of a 72-year-old female patient admitted to the ophthalmology clinic for a large round-oval tumor with a long-standing keratotic lesion on her lower eyelid, without extending to the free margin of the eyelid. The tumor was excised with a margin in non-tumorous tissue, the nearest being 1 mm away from the tumor at the 12 o’clock position. The surgical process was complicated by the patient’s treatment with the anticoagulant rivaroxaban, resulting in increased bleeding during surgery. The histopathological evaluation showed characteristics indicative of a well-differentiated squamous cell carcinoma, more specifically, the keratoacanthoma type. Consequently, it was necessary to extend the excision at the 12 o’clock position by an additional 3 mm. The procedure involved extensive removal of the impacted area and subsequent reconstruction with advancement flaps, supported by histological examination to ensure total excision. In cases of squamous cell carcinoma on the eyelid, multiple sequential excisions are often required to ensure complete removal within safe histological margins, achieving desirable functional and esthetic results.