The paper presents our approach to reconstruction after periocular basalioma (pBCC) excision, especially of large
lower lid (LL) and medial canthal (MC) pBCC. Retrospective analysis of data of 123 patients with pBCC, confirmed on
histologic examination (HE), operated in period from 1998 to 2006, was performed. Oncologic safety margins of 3 mm
were marked after local anesthesia was administered. Reconstruction was done in time of surgery. In pBCC away from a
lid margin, adjacent myocutaneous flaps were used. For lid margin involving (LM) pBCC, size of 10 mm and less in horizontal
diameter (HD), full-thickness lid excision was performed, combined with lateral canthotomy and/or Tenzel or
McGregor flap. When size of LM pBCC was more than 10 mm in HD and it was on a LL, ipsilateral upper lid (UL)
tarsoconjunctival (TC) graft combined with single pedicle transposition myocutaneous flap were used. The same size of
LM pBCC on a UL required ipsilateral full-thickness LL “switch” flap and/or contralateral LL Hübner graft. In MC
pBCC combined approach was used. The follow-up was up to 5 years. The 19 patients (15.4%) had positive tumor margin
on HE. Five of them refused further surgery, but only two had recurrence. The rest of 121 patients had no recurrence during
follow-up. In 5/14 patients, who underwent additional surgery, no tumor cells were found on HE. The 10/123 patients
(8.1%) had complications. The imperative of our approach to reconstruction after pBCC was good functional and
cosmetic result, avoiding prolonged lid closure. Accordingly, in large LL LMpBCC we used ipsilateral UL TC graft combined
with single pedicle transposition myocutaneous flap. In MC pBCC combined approach was mandatory