In most people’s mind, Oculoplastic Surgery deals only with cosmetic procedures to rejuvenate the eyes and face. Nevertheless, we must not forget that this surgical specialty also deals with reconstructive and functional conditions that affect many individuals. One of these conditions is skin cancer affecting the eyelids.
Why is treatment of eyelid skin cancer important?
Skin cancer on the face is very common, and the eyelid is no exception. It is more common in adults between 50 and 80 years of age, and in individuals with fair skin. The main causative factor is sun exposure; however, this refers to exposure in childhood and early adulthood, not recent exposure. This also explains the necessity of daily sun protection, especially in children and young adults. Prevention is the best treatment. On the other hand, once eyelid skin cancer has been detected, treatment becomes very important since untreated cancer can cause significant visual and aesthetic problems. Eyelid skin cancer can deform an eyelid and put the eyeball at risk if it is not removed in time.
Treatment of eyelid skin cancer
The treatment of eyelid skin cancer will depend on several factors such as the type of cancer, the aggressiveness of the condition, its extension, and location. It is also necessary to confirm that the cancer has not traveled outside the eyelid to the eye or orbit. Therefore, in some cases a CT scan or MRI may be required.
The most common type of eyelid skin cancer is Basal Cell Carcinoma (BCC). About 90% of all eyelid cancers are the basal cell skin cancer type. The good news is that this is perhaps the most “benign” of all cancers as it only tends to produce local tissue damage and does not travel to other organs (metastasis). BCC usually appears as a reddish nodule on the eyelid that does not heal with topical treatments. Once the diagnosis is made with a biopsy, the cancer can be excised and the eyelid reconstructed. The sooner the cancer is diagnosed, the easier it is to remove, thus ensuring a better result. In cases with a small-sized cancer, removal and simple reconstruction can be accomplished using just local anesthesia. However, if the cancer is large, it may require extensive tissue removal and complex reconstruction with local anesthesia plus sedation. The best treatment for large BCC is Mohs surgery.
Squamous cell carcinoma (SCC) is a more aggressive type of skin cancer with a worse prognosis than BCC because it causes more tissue damage and has a higher probability to metastasize to other organs. This cancer also requires more extensive removal, thus making the reconstruction more complicated. Mohs surgery is also the best alternative for the treatment of SCC.
The location of the cancer will also dictate the type of treatment needed. Reconstruction of defects on the lower eyelid tend to be easier than the upper eyelid or the inner or outer angles of the eye.
Mohs surgery for treatment of basal cell and squamous cell carcinoma
Mohs surgery is the treatment of choice for most eyelids cancers that are not melanoma. This is a surgical technique that allows the surgeon to remove only the affected skin. It is performed by dermatologists that have received special training in the technique. Mohs surgery gives the best prognosis of all procedures because it spares any tissue that has been invaded by the cancer.
It is not always necessary to perform Mohs surgery, especially in small carcinomas that are well-defined. Mohs surgery can be very expensive and is not the best option for all eyelid malignancies. A consultation with your surgeon is very important to decide if you are a good candidate for this kind of operation.
Eyelid skin cancer treatment in Costa Rica
At ArteFacial, our oculoplastic surgeon has extensive experience in the diagnosis and surgical treatment of eyelid skin cancer. He has performed hundreds of procedures to remove eyelid tumors and has extensive experience in eyelid reconstruction after Mohs surgery.