Due to a lifetime of sun exposure, skin cancers are commonly found in the eyelid region. Basal cell carcinoma is, by far, the most common skin cancer, followed by squamous cell carcinoma, then much more rarely melanoma or sebaceous cell carcinoma, which though extremely rare has a propensity to occur in the eyelid region.
Symptoms: Presentation of these eyelid cancers can be subtle, including a small non-resolving bump mimicking a chalazion, a localized area of loss of lashes, a small notch within the lid margin, or localized area of skin breakdown with chronic bleeding or discharge.
Diagnosis: Careful examination and biopsy of suspicious lesions confirms the diagnosis of skin cancer.
Treatment (Excision / Reconstruction):
Excision of skin cancer
Complete surgical excision and reconstruction of the resultant defect is the best way to treat skin cancers. Depending upon the type ( and subtype) of skin cancer, it’s clinical appearance, location, and whether or not it is a recurrent tumor will determine the recommended method of tumor removal. The goal of eyelid tumor removal is straightforward: complete removal of the tumor while sparing normal surrounding tissue. The eyelid real estate is quite limited and valuable, so it is very desirable to preserve as much normal tissue as possible to facilitate the reconstruction of the tumor defect. Thus, in select cases, Mohs’ micrographic surgery is advised. Mohs’ surgery is performed by a specially-trained dermatologic surgeon who removes the tumor precisely in stages to insure the complete removal of the entire skin cancer ( to prevent recurrence) and maximal preservation of surrounding tissues to facilitate repair. Dr. Rubin performs reconstructive surgery
Reconstruction of the defect is directed at two aligned goals: 1) Maintenance of the position and function of the eyelids ( to protect the eye) and 2) Creating the best cosmetic outcome. Based upon the patient’s underlying anatomy and the extent of the tumor defect, Dr. Rubin customizes the reconstruction in every case. In straight forward repairs the local tissues can be directly closed. However in more complex cases a wide range of potential reconstructive techniques may be used, including: rearrangement of local tissue ( “flaps”) or skin grafts harvested to match the delicate eyelid skin.
Basal Cell Carcinoma Right Lower Lid, 22 year-old Male
Basal cell carcinoma of right lower lid pre-op ( left), following Mohs excision of tumor with resultant 60% defect of lower eyelid; first stage repair included a flap from the upper to lower lid to restore the mucous membrane ( conjunctiva ) and soft tissue support ( tarsus) of the back side of the eyelid. The front portion of the lid was repaired with skin and muscle flap from the lower lid. After division of the flap 4 weeks after surgery, the lower lid’s function and appearance was restored.
Basal Cell Carcinoma, 94 year-old Female
Left: Pre-operative appearance with a basal in the upper eyelid and a coincidental outward turning of the lower lid ( ectropion). Center: Appearance after Mohs excision of skin cancer. Right: Post-op appearance after closure of the upper lid defect and repair of the ectropion of the lower lid.
Basal Cell Carcinoma , 57 year-old male
Left: Large, neglected basal cell carcinoma of the outer corner of the left eye
Center: Following Mohs excision of tumor. Defect was closed with a rotational flap from the cheek.
Right: Post-operative appearance
Basal cell carcinoma right lower lid, 72 year-old male
Left: Pre-operative appearance
Center: Following Mohs excision of tumor
Right: Post operative appearance