{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T05:06:24Z","timestamp":1784696784949,"version":"3.55.0"},"reference-count":28,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T00:00:00Z","timestamp":1784678400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Large full-thickness lower eyelid defects following Mohs micrographic surgery (MMS) for basal cell carcinoma (BCC) present a substantial reconstructive challenge. This challenge is further compounded in elderly patients with systemic comorbidities, for whom general anesthesia and staged procedures carry risks that must factor into technique selection. We illustrate this in an 84-year-old woman with advanced chronic kidney disease.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>An 84-year-old woman with chronic renal insufficiency (estimated glomerular filtration rate 15.96 mL\/min\/1.73 m\u00b2, serum creatinine 249.9 \u03bcmol\/L; chronic kidney disease stage G4) presented with a progressively enlarging, ulcerated nodular-type BCC on the right lower eyelid. Following two stages of MMS, a 2.6\u00a0cm \u00d7 1.6\u00a0cm full-thickness defect remained. Single-stage reconstruction was performed under local anesthesia using an autologous buccal mucosal graft for the posterior lamella and an orbicularis oculi myocutaneous flap for the anterior lamella. The flap demonstrated normal perfusion immediately after surgery. At approximately six-month follow-up, complete eyelid closure and restored lid function were maintained, with a stable, natural lid contour and no clinical signs of graft contracture, ectropion, corneal exposure, or local tumor recurrence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This case suggests that autologous buccal mucosal graft combined with an orbicularis oculi myocutaneous flap may offer a viable single-stage reconstructive option for large full-thickness lower eyelid defects following MMS, and may be particularly relevant for elderly patients with systemic comorbidities. Given the single-case design and limited follow-up duration, prospective evaluation in larger series is needed to confirm these preliminary findings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fonc.2026.1888362","type":"journal-article","created":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T04:42:51Z","timestamp":1784695371000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Autologous buccal mucosal graft combined with orbicularis oculi myocutaneous flap for single-stage reconstruction of full-thickness lower eyelid defects following Mohs micrographic surgery: a case report with literature review"],"prefix":"10.3389","volume":"16","author":[{"given":"Jian-Yu","family":"Xiong","sequence":"first","affiliation":[{"name":"School of Medicine, Jianghan University","place":["Wuhan, Hubei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ming-Xia","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Renmin University Hospital","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Na","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Wuhan No.1 Hospital, Wuhan","place":["Hubei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jing","family":"Xiao","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Wuhan No.1 Hospital, Wuhan","place":["Hubei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ying-Hua","family":"Song","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Wuhan No.1 Hospital, Wuhan","place":["Hubei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liang","family":"Zheng","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Wuhan No.1 Hospital, Wuhan","place":["Hubei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liang","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Wuhan No.1 Hospital, Wuhan","place":["Hubei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,22]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.3390\/ijms25158452","article-title":"Dysembryogenetic pathogenesis of basal cell carcinoma: the evidence to date","volume":"25","author":"Nicoletti","year":"2024","journal-title":"Int J Mol Sci"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1097\/IOP.0000000000002391","article-title":"Reconstruction of large full-thickness lower eyelid defects with remnant eyelid rotation, semicircular skin and muscle flap, and lateral tarsoconjunctival flap","volume":"39","author":"Camacho","year":"2023","journal-title":"Ophthalmic Plast Reconstr Surg"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1007\/s00403-021-02261-8","article-title":"Basal cell carcinoma histopathologic upgrading and Mohs micrographic surgery: a single institution, retrospective review","volume":"314","author":"Walocko","year":"2022","journal-title":"Arch Dermatol Res"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejca.2023.113254","article-title":"European consensus-based interdisciplinary guideline for diagnosis and treatment of basal cell carcinoma\u2014update 2023","volume":"192","author":"Peris","year":"2023","journal-title":"Eur J Cancer"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1007\/s40123-022-00532-9","article-title":"Surgical strategies for eyelid defect reconstruction: a review on principles and techniques","volume":"11","author":"Yan","year":"2022","journal-title":"Ophthalmol Ther"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.3389\/fmed.2022.893063","article-title":"Basal cell carcinoma and hedgehog pathway inhibitors: focus on immune response","volume":"9","author":"Gambini","year":"2022","journal-title":"Front Med (Lausanne)"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.3390\/cancers15143621","article-title":"Sonidegib in locally advanced basal cell carcinoma: a monocentric retrospective experience and a review of published real-life data","volume":"15","author":"Nazzaro","year":"2023","journal-title":"Cancers (Basel)"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1113713","article-title":"Efficacy and safety of vismodegib in advanced basal-cell carcinoma","volume":"366","author":"Sekulic","year":"2012","journal-title":"N Engl J Med"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(21)00126-1","article-title":"Cemiplimab in locally advanced basal cell carcinoma after hedgehog inhibitor therapy: an open-label, multi-centre, single-arm, phase 2 trial","volume":"22","author":"Stratigos","year":"2021","journal-title":"Lancet Oncol"},{"key":"B10","doi-asserted-by":"publisher","first-page":"10161","DOI":"10.4081\/dr.2026.10161","article-title":"The role of a multidisciplinary approach in non-melanoma skin cancer management","volume":"18","author":"Lussana","year":"2026","journal-title":"Dermatol Rep"},{"key":"B11","article-title":"New progress in diagnosis and treatment of eyelid basal cell carcinoma","volume":"40","author":"Gao","year":"2025","journal-title":"Eye Sci"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1177\/11206721211035633","article-title":"Oculoplastic surgeries in patients older than 90 years of age","volume":"32","author":"Abumanhal","year":"2022","journal-title":"Eur J Ophthalmol"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1007\/s00403-022-02507-z","article-title":"Mohs micrographic surgery for periocular skin cancer: a single-institution experience","volume":"315","author":"Shi","year":"2023","journal-title":"Arch Dermatol Res"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.3969\/j.issn.1674-8468.2025.08.012","article-title":"New progress in the treatment of cutaneous basal cell carcinoma","volume":"32","author":"Zhang","year":"2025","journal-title":"J Diagn Ther Dermato-Venereol"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1097\/SCS.0000000000003783","article-title":"Lower eyelid reconstruction after ablation of skin Malignancies: how far can we get in a single-stage procedure","volume":"28","author":"Yordanov","year":"2017","journal-title":"J Craniofac Surg"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1097\/SCS.0000000000002236","article-title":"Synchronous basal cell carcinoma of the inferior eyelid\u2014combined surgical approach for single-stage ablation","volume":"27","author":"Yordanov","year":"2016","journal-title":"J Craniofac Surg"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpra.2024.08.009","article-title":"Comparative evaluation of conventional and modified Hughes procedures in reconstructing large full-thickness defects of the lower eyelid","volume":"42","author":"Zhang","year":"2024","journal-title":"JPRAS Open"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.79129","article-title":"Basal cell carcinoma of the right lower eyelid treated with tarsoconjunctival and Mustard\u00e9 flaps","volume":"17","author":"Anastasopoulos","year":"2025","journal-title":"Cureus"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1007\/s00403-023-02559-9","article-title":"Periorbital reconstructive techniques following Mohs micrographic surgery or excisions: a systematic review","volume":"315","author":"Archibald","year":"2023","journal-title":"Arch Dermatol Res"},{"key":"B20","doi-asserted-by":"crossref","first-page":"24","DOI":"10.21037\/fomm-21-80","article-title":"Posterior lamella substitutes in full-thickness eyelid reconstruction: a narrative review","volume":"5","author":"Guo","year":"2023","journal-title":"Front Oral Maxillofac Med"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1002\/btm2.10497","article-title":"Biomaterials and tissue engineering strategies for posterior lamellar eyelid reconstruction: replacement or regeneration","volume":"8","author":"Yan","year":"2023","journal-title":"Bioeng Transl Med"},{"key":"B22","doi-asserted-by":"publisher","first-page":"465","DOI":"10.1186\/s12886-022-02692-5","article-title":"Buccal mucosal membrane graft for correction of cicatricial lower eyelid retraction","volume":"22","author":"Rafizadeh","year":"2022","journal-title":"BMC Ophthalmol"},{"key":"B23","first-page":"99","article-title":"Clinical effect of local flap combined with allogeneic sclera transplantation in repairing eyelid defect after eyelid Malignant tumor resection","volume":"20","author":"Bai","year":"2020","journal-title":"Pract Clin Integr Tradit Chin West Med"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.3969\/j.issn.1673-3835.2021.01.005","article-title":"Comparative study on the effect of orbicularis oculi myocutaneous flap and kite flap combined with double eyelid plasty in repairing anterior lamella defect of eyelid after eyelid tumor resection","volume":"16","author":"Lu","year":"2021","journal-title":"Pract J Prev Blind"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.1007\/978-981-16-7345-0_5","article-title":"Clinical application of orbicularis oculi muscle pedicled rotated flap in repairing surgical wounds of eyelid skin tumors","volume":"18","author":"Xiong","year":"2019","journal-title":"J Dermatovenerol Integr Tradit Chin West Med"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.7181\/acfs.2018.02061","article-title":"Usefulness of the orbicularis oculi myocutaneous flap in periorbital reconstruction","volume":"19","author":"Kim","year":"2018","journal-title":"Arch Craniofac Surg"},{"key":"B27","doi-asserted-by":"publisher","first-page":"241","DOI":"10.1007\/s10792-025-03651-x","article-title":"Clinical observation on the repair of inferomedial eyelid defects with temporal island flaps pedicled with the orbicularis oculi muscle","volume":"45","author":"Liu","year":"2025","journal-title":"Int Ophthalmol"},{"key":"B28","article-title":"Repair of 32 cases of severe full-thickness eyelid defect","volume":"23","author":"Wang","year":"2019","journal-title":"Chin J Lab Diagn"}],"container-title":["Frontiers in Oncology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2026.1888362\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T04:43:14Z","timestamp":1784695394000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2026.1888362\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,22]]},"references-count":28,"alternative-id":["10.3389\/fonc.2026.1888362"],"URL":"https:\/\/doi.org\/10.3389\/fonc.2026.1888362","relation":{},"ISSN":["2234-943X"],"issn-type":[{"value":"2234-943X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,22]]},"article-number":"1888362"}}