EYELID CANCER

The most common eyelid skin cancer is basal cell carcinoma, which fortunately has a 99 % chance of definitive cure, when treated properly. The Mohs technique allows us to remove the tumor and study the 360 degrees of the excised edge to achieve the maximum cure rate, while sacrificing as little as possible healthy tissue. The modern eyelid reconstruction techniques make it possible to solve the defect that remains after removing the cancer, in order to achieve excellent results, both from the functional and esthetic point of view.
Basal cell carcinoma or epithelioma is a locally invasive tumor, and metastasis is rare. Another eyelid skin tumor is squamous cell carcinoma, which is more aggressive. Melanomas rarely occur on the eyelids and are tumors that should be treated early. Sebaceous carcinoma is a rare tumor, which should also be removed in full.

MOHS SURGERY

Mohs surgery is a skin cancer removal technique that offers the maximum cure rate, while sacrificing as little as possible healthy tissue. The eyelids and periocular area have a high incidence of skin cancer, especially basal cell carcinoma. Some locations are particularly dangerous, such as the medial canthal region (the area between the eye and the nose).
The periocular area is considered to be at high risk, and Mohs surgery is particularly indicated. International studies and some large series performed in our country show that the cure rate when the tumor is treated for the first time is 99 %.
When it is a recurrent tumor (i.e., it was previously treated and it reappeared), the success rate is 95 %.
The technique consists of removing the visible tumor, and then a thin layer 360 degrees around the tumor. This layer is divided into sections that are evaluated under microscope on the spot to determine the presence of the tumor.
If the tumor is present, a second removal of a thin layer is performed, but only from the affected area. In this way, only the affected tissue needs to be removed. This process continues until the entire surface is tumor-free.
The defect resulting from the removal of the tumor is reconstructed at the same time or the next day. The best results are obtained by using oculoplastic surgery techniques.

What does an eyelid tumor look like?

Basal cell carcinoma or epithelioma appears as a hard lesion, with pearly edges and dilated vessels on the surface. It alters the normal structure of the skin in the eyelid area and it may bleed. There is usually loss of eyelashes.
This tumor does not typically cause pain, which sometimes leads patients to think that it is an unimportant lesion. This condition grows very slowly, over several months or years, so it is never an emergency. However, if it is not treated properly, its gradual progression can lead to the complete destruction of the eyelid and put the eyeball at risk due to deep invasion.

Like other types of skin cancer, eyelid skin cancer can be caused by excessive exposure to sunlight during childhood, particularly in very fair-skinned people. Therefore, it is highly advisable to use sunscreen every day, and in case of sun exposure, reapply it every 3 hours. Sunglasses and hats are also excellent options.
The first step when a malignant lesion is suspected is a biopsy. This can be performed in the office and can confirm the type and variety of the tumor. The most effective treatment for skin cancer is microsurgery to remove the entire lesion. The most recommended method is the Mohs technique, which provides a 99 % cure rate in primary tumors and preserves as much healthy tissue as possible. This technique microscopically analyzes the entire surface of the tumor during surgery. Once the entire cancer has been removed, it is necessary to reconstruct the defect that has remained after removal. The specific technique used depends on the size and location of the defect. Thanks to modern microsurgery techniques, it is possible to completely reconstruct an upper or lower eyelid and achieve a very good functional and esthetic result.
No, skin cancer or basal cell carcinoma originates locally and is not an extension of cancer present in another area of the body.
If the tumor is detected early, it is rare for the eye to be involved. However, it should be noted that tumors that have grown for months or years may involve the eyeball. If the tumor has not reached the eye, vision and the eyeball are not affected.

BEFORE AND AFTER

case 1

before:

Young patient with high sun exposure due to practicing surfing. History of basal cell carcinoma of the left lower eyelid, treated previously. Note the loss of normal eyelid structure.

after mohs:

Young patient with high sun exposure due to practicing surfing. History of basal cell carcinoma of the left lower eyelid, treated previously. Note the loss of normal eyelid structure.

Recovery:

Young patient with high sun exposure due to practicing surfing. History of basal cell carcinoma of the left lower eyelid, treated previously. Note the loss of normal eyelid structure.

after:

Young patient with high sun exposure due to practicing surfing. History of basal cell carcinoma of the left lower eyelid, treated previously. Note the loss of normal eyelid structure.
testimony

case 2

before:

This patient presented a non-painful lesion that appeared several months ago. Absence of eyelashes and sporadic bleeding. Biopsy showed a malignant lesion: basal cell carcinoma.

after mohs:

The Mohs technique permits the removal of the entire tumor and its margins with a maximum cure rate (99 %) and the least loss of healthy tissue. Note that the defect is larger than the lesion, due to the microscopic extent of the tumor.

after:

Tissues from both upper eyelids were used for reconstruction, offering a very satisfactory esthetic and functional result.

case 3

before:

Patient with non-painful tumor in the right lower eyelid.

after mohs:

After complete excision of the lesion, a 50 % defect of the eyelid remains.

after:

Result of reconstruction, after 6 months.
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