Eyelid Cancer Surgery
Skin Cancer of the Eyelids and Face
Skin cancer often involves the skin of the eyelid or adjacent face. Eyelid skin cancers occur most often on the lower eyelid but may also be found on the eyelid margins, corners of the eye, eyebrow skin or adjacent areas of the face.
- Skin cancer of the eyelid appears usually as a slowly enlarging lump usually on the lower eyelid. The most common type is “basal cell” cancer, which usually is a firm, pearly nodule which is non-tender. If present at the edge of the eyelid, there may be a loss of eyelashes. Another type of skin cancer of the eyelid resembles a chronic infection of the lid, or blepharitis, with redness of the lid. Melanoma can involve the outside or inside of the eyelid, and usually is a changing, darkly pigmented growth. Sometimes melanomas have no pigment.
- Usually the cancer appears as painless elevations or nodules. Occasionally, the eyelashes are distorted or missing. There may be ulcerations of the involved area along with bleeding, crusting and/or distortion of the normal skin structure. Such findings need to be evaluated and may require a biopsy to confirm the diagnosis of skin cancer.
- The most common types of skin cancers are basal cell carcinoma and squamous cell carcinoma. Both types enlarge locally and usually do not spread (metastasize) to distant parts of the body. However, if not completely removed, either type will invade adjacent structures.
- It is important to know that basal cell and squamous cell carcinomas are relatively slow-growing. Thus, when detected early and treated in a prompt and appropriate manner, there is a better chance of removing the tumor completely and minimizing the amount of tissue affected by the carcinoma.
Principles of Skin Cancer Management
There are three very important principles in the management of eyelid skin cancers:
- Complete removal and
- Reconstruction of the area to preserve vision
After these two are achieved, the final, important principle is for the fully trained eye and facial surgeon to design the surgery to give the optimal cosmetic result.
Although radiation treatment may be effective, because of the risks of serious side effects, it is almost exclusively reserved for debilitated patients.
Complete removal of the tumor is critical to minimize the possibility of recurrence, which is even more difficult to manage. The surgeon may remove the tumor and have a pathologist check the tissue margins (“frozen section”) to be sure the tumor is completely removed. In another method, a dermatologic surgeon excises the tumor in a special way (“Mohs technique”) to insure total removal.
Once the tumor has been completely removed, reconstructive surgery is usually necessary. Many excellent techniques are available to reconstruct almost any surgical defect. The surgery is performed as an outpatient (there is usually no need for hospitalization). Local anesthesia, which numbs the eyelid, is combined with light sedation so there is little, if any, pain during or even after surgery.
To effectively treat skin cancers of the eyelids and face requires a special understanding of the anatomy and pathophysiology of the eyelid. The excellent general plastic surgeon who does tummy tucks and breast augmentations almost NEVER has been trained in eyelid anatomy or pathophysiology and should NOT be the one you choose to treat your eyelid and facial skin cancer, which should be treated only by a fully fellowship trained oculofacial surgeon. Fellowship in the American Society of Oculo-facial Plastic and Reconstructive Surgery (ASOPRS) indicates that the surgeon has greatest specialized training and expertise in this subspecialty.
If you have skin cancer of the eyelid or face, please contact Dr. Kass who is fully trained to treat this problem and has been in practice in St. Petersburg for over 27 years.