SYSTEMATIC REVIEW article
Front. Med.
Sec. Ophthalmology
Factors Associated With Tumour Recurrence and Recurrence Risk in Surgically Treated Periorbital Basal Cell Carcinoma: A Systematic Review and Meta-analysis
Imam Muhammad ibn Saud Islamic University, Riyadh, Saudi Arabia
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Abstract
Background Basal cell carcinoma (BCC) is the most common malignant skin tumour. Periorbital BCC presents unique oncological and reconstructive challenges due to its proximity to vital ocular structures. Recurrent lesions often behave more aggressively and are associated with poorer prognosis than primary tumors. Objective The current meta-analysis was performed to retrieve the risk of recurrent surgically treated periorbital BCC. Furthermore, factors associated with recurrent surgically treated periorbital BCC were evaluated to identify patients at higher risk of poor outcomes. Methods The literature review was performed through twelve databases on the 5th of November, 2024. All clinical studies comparing the demographic characteristics, tumour characteristics, and surgical-related data among patients with recurrent and no-recurrent surgically treated periorbital BCC were included. Results The present study included nine articles, encompassing 1892 patients with surgically treated periorbital BCC. There were 210 recurrence events with a risk of 11.4% (95%CI; 7.3% to 17.5%). The risk of tumour recurrence was significantly higher among patients with upper eyelids (RR; 1.68, 95%CI; 1.05, 2.70, P=0.03) and inner canthus lesions (RR; 1.60,95%CI; 1.22, 2.11, P=0.0008). Patients with superficial multicentric lesions (RR; 3.15, 95%CI; 1.56, 6.35, P=0.001) and patients with infiltrative/sclerodermiform lesions (RR; 2.19,95%CI; 1.59, 3.02, P<0.001) were at higher risk of tumour recurrence. Patients with positive resection margins and patients with nonradical excision of the primary tumours were 3.55 and 2.71 times at higher risk of periorbital recurrence, respectively. 3 Conclusion Patients with surgically treated periorbital BCC are at substantial risk of tumor recurrence. Lesions located on the upper eyelid or inner canthus, as well as aggressive histological subtypes, carry a higher recurrence risk. Importantly, Mohs micrographic surgery remains the standard treatment in this area, ensuring complete tumor removal and minimizing recurrence. Patients with high-risk features should undergo meticulous surgical management and close follow-up.
Summary
Keywords
basal cell carcinoma, Eyelid, Periorbital, Recurrence, risk
Received
09 August 2025
Accepted
07 January 2026
Copyright
© 2026 Alessa. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Dalal Alessa
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