Standard of care in treating periocular basal cell carcinoma: a narrative review of the recommendations from the German S2k guidelines

Background and Objective: The German S2K guideline offers an in-depth review of basal cell carcinoma (BCC). This review aimed to briefly summarize the German S2K guidelines of diagnostic and therapeutic strategies in BCC with special focus on periorbital BCCs. Methods: A summary was created based on the German S2K guidelines and additional English and German literature searched on PubMed published after 2010. Key Content and Findings: The review summarizes the state-of-the-art care for BCC in Germany and focus on aspects for periocular BCC and therefore give recommendations to handle these tumors. Conclusions: BCCs pose the most common malignant skin growth. Risk factors such as intensified UV radiation exposure, recurrent sunburns and activation of the sonic hedgehog pathway are well established variables. Although alternative treatment options in more complicated or neoadjuvant settings have become more available, complete surgical removal still remains the gold standard for periocular BCCs. Treatment of periorbital BCCs follow the same principles, but often state a therapeutic problem as anatomical integrity of the eyelid and adnexa are crucial for the eye and visual function. A combination of systemic treatment and neoadjuvant or adjuvant approaches before or after surgery are promising options for a successful outcome which can further improve the standard treatment for locally advanced BCCs. Surgical removal of BCCs often followed by anatomical reconstruction still remains as the first line therapy of choice. Alternative therapy approaches for periocular BCC are available and have become more prevalent. However, these are only indicated when microscopically controlled excision with subsequent oculoplastic reconstruction is not possible. The discussion of each case within a tumor board is compulsory, and also in line with national guidelines.