Eyelid Cancer Excision and Reconstruction
The eyelids are particularly susceptible to the development of skin cancer. The upside is that they are usually nonmelanoma forms of cancer — basil cell and squamous cell carcinomas. In fact, eyelid skin cancers account for up to 10 percent of all skin cancers, with 95 percent of these tumors being either basil cell or squamous cell carcinomas. These cancers need to be removed and the eyelid often needs reconstruction for function or aesthetic purposes. We perform both sides of the procedure at the Eye Institute at the Medical Center Clinic.
Not melanoma, but serious just the same
As noted above, skin cancers on the eyelids are usually basil cell carcinomas or squamous cell carcinomas. Both of these types of cancer enlarge locally and usually do not spread (metastasize) to distant parts of the body. However, they still merit serious attention because if they are not removed they can invade adjacent structures. Both types of skin cancer are relatively slow growing, so early detection dramatically increases the successful removal of the tumor without having to take more adjacent tissue than is absolutely necessary.
Removal of the skin cancer
Eyelid skin cancers most often form on the lower eyelid, but they may be found anywhere on the eyelid margins. If possible, Mohs’ surgery is used to remove the tumor. In Mohs’ surgery the visible tumor is removed along with a small area around the tumor. Then, with the patient still under anesthesia, the tissue taken is examined under a microscope, with particular attention paid to the margins. If the margins are clear of any cancer cells, the procedure is completed. If additional cancerous cells are found in the margins, additional tissue is removed until the margins are clear.
Mohs’ surgery for eyelid cancer has a very high success rate, with five-year cure rates of up to 99 percent. Plus, it has the advantage of taking only the smallest amount of skin beyond the tumor.
Reconstruction
Reconstruction of the eyelid is typically performed within one to two days after the Mohs’ procedure. We employ various methods depending on the size of the tumor being removed. The complexity of the reconstruction is unique to every procedure, but the main goal is to restore adequate eyelid, brow, and facial function. We also seek to minimize scarring. In some cases, secondary surgical procedures are necessary to modify scarring, improve eyelid function and position, and correct any tear duct issues.
