The incidence of skin cancer is greater on the lower eyelid and inner canthus of the eye, but the upper eyelid may also be compromised. The most common malignant tumor of the eyelid skin is basal cell carcinoma, followed by squamous cell. The former is by far the most frequent type. Basal cell typically grows at a slow rate and has a relatively benign behavior. Squamous cell carcinoma, on the other hand, is very aggressive and tends to spread to other organs.
Treatment for eyelid skin cancer is always surgical. If the mass is detected early on the course of the disease, the operation to remove the tumor can be quite simple and may only require a small reconstruction. On the contrary, advanced carcinomas demand the removal of much tissue, and consequently, require very complex reconstructive surgery.
The upper eyelid is arguably the most difficult area to reconstruct after cancer removal. There is a plethora of tissues that are intricately arranged to produce delicate movements and maintain the integrity of the ocular surface. Furthermore, subtle variations in the anatomy of the upper eyelid can have detrimental effects on facial appearance. Therefore, the surgeon is faced with the difficult task of restoring normal eyelid function while seeking to preserve the aesthetics of the eye.
Reconstruction of large defects of the upper eyelid, i.e., those comprising more than 75% of the eyelid, can be very challenging, to say the least. Currently, an eyelid-sharing procedure in which the lower eyelid is used to reconstruct the upper eyelid serves as the best surgical approach. The technique is named after the surgeons who first described it in 1955. The Cutler-Beard technique consists of advancing tissue from the lower eyelid to fill the upper eyelid defect.
In this video-blog, we demonstrate how to perform a modified Cutler-Beard flap and show the results of the operation.
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