Management of a rare case of recurrent primary cutaneous mucinous carcinoma of the upper eyelid

Primary cutaneous mucinous carcinoma (PCMC) is a rare, low-grade adnexal neoplasm with a propensity for local recurrence, particularly in the periorbital region where complete excision is challenging. We report a 48-year-old woman who developed recurrent PCMC in the superomedial left upper eyelid one year following initial incomplete excision with positive deep margins and perineural invasion. Magnetic resonance imaging revealed a 20 × 21 × 28 mm heterogeneous mass. The patient underwent wide local excision with 5–10 mm margins under intraoperative frozen-section control, achieving clear margins and necessitating partial resection of the lacrimal gland complex. The resulting 3 × 3 cm defect was reconstructed immediately with a rotation-advancement myocutaneous flap. Final histopathology confirmed negative margins with no residual tumor. Postoperative recovery was uneventful, with excellent functional and esthetic outcomes and no complications at follow-up. This case highlights the efficacy of frozen-section-guided excision combined with rotation-advancement flap reconstruction in managing recurrent periorbital PCMC, ensuring oncologic clearance while preserving eyelid function and cosmesis.