Eyelid and Skin Cancer Reconstruction

Skin cancers can involve the face or the eyelids. In India, sebaceous gland carcinoma is the most common type of skin cancer involving the eyelids. It usually presents as an elevated nodule with yellowish nodules within. There are fine blood vessels on the surface. Other less common tumors are basal cell carcinoma and squamous cell carcinoma.

Most skin cancers are painless nodules, sometimes pigmented, and may bleed occasionally. They rarely spread to other regions of the body, and are usually not life threatening. When the cancer is removed and the region is reconstructed, the patient is essentially cured. There is a 5% or less chance that the cancer may recur, hence periodic check-up is needed.


Skin cancer of left lower eyelid (Basal cell carcinoma) and a simple mole treated with surgical removal and skin grafting.

Surgical Technique:
Management of any eyelid or skin cancer involves two major steps: complete removal, and subsequent reconstruction. Currently, histopathological confirmation during surgery (Frozen section) is the best method to ensure complete removal of the tumor. Reconstruction of the face after removal of the cancer is dependent on the size and location of the defect. Flaps, skin grafts and other options are available. A flap is a technique whereby adjacent skin is rotated into the deficient area. Skin grafts (taken from behind the ear or opposite eyelid) are also sometimes used to reconstruct the defects. Ideally, the skin graft should match in color and complexion. Occasionally, eyelid-sharing procedures are needed which are done in 2 stages performed 6-8 weeks apart.

Surgical Time and Recovery:
Surgery for eyelid cancers vary widely in their complexity and duration based on the location and extent of the tumor. Small tumors can be removed under local anesthesia and take about 1-3 hours including reconstruction time. More often, general anesthesia is preferred. Stitches are removed in 7-10 days. Most patients are back to light work within a week or two. Minimal bruising may persist for 1-2 weeks.

Note:
Cancer surgery may need skin graft, cartilage graft, and complex periocular flaps as a part of the reconstruction. Extensive eyelid tumors involve permanent loss of lashes after reconstruction. Recurrence though rare is possible, either within the original site or within a draining lymph node (around the ears, jawline and neck). Extensive tumors spreading into the orbit may need simultaneous removal of the eyeball, even if vision seems to be good.

Insurance:
Health insurance will cover the costs of cancer surgery.

Other Procedures:
Other commonly performed reconstructive procedures include correction of Eyelid Lift (Blepharoplasty), Entropion, Ectropion, Eyelid Drooping, Facial Spasms, Facial Paralysis, Watering Eyes, Thyroid Eye Disease, Orbital Surgery, and Trauma and Maxillofacial Surgery