In extensive basal cell carcinoma involving both upper and lower eyelids and the lacrimal gland, is radiotherapy poorly tolerated (especially to doses up to 50-60 Gy) and/or is orbital exenteration preferred?

For advanced basal cell carcinoma with orbital invasion, I would treat with hedgehog inhibitors. If there is an inadequate clinical response, exenteration is usually recommended. Radiation is not particularly effective for BCC and can have significant ocular side effects.