A lesion not to be overlooked.

A 61-year-old male presented with a fungating ulcer over his left inferior peri-orbital region. The tumour fi rst started 10 years ago as a small lesion on his lower eyelid and over the last 2 years, it had grown rapidly, causing a loss of vision of the left eye. He otherwise was systemically well. Clinical examination revealed a large ulcer with irregular, raised borders and impetiginisation (yellow crusting) evident at its superior margin (Fig.1). The ulcer had a necrotic centre and had caused a complete destruction of the anatomy of the left eye. No cervical lymphadenopathy was detected and there was an incidental parotid swelling on the contralateral side. Computed tomography (CT) of the orbit did not reveal any orbital or bony involvement but magnetic resonance imaging (MRI) of the orbit demonstrated breaching of the fl oor of the left orbit (maxilla) and infi ltration of the left lacrimal sac by tumour (Fig. 2).