Dr. Fante and Dr. Hawes are the authors of the definitive chapter on eyelid reconstruction in the #1 surgical textbook on the subject: the authoritative Local Flaps in Facial Reconstruction, considered among the essentials in plastic surgery education. Our team is among the world’s most experienced and respected in this field and will use the best possible strategies to restore normal appearance and function when eyelid reconstruction is needed.
What are the most common types of eyelid cancer?
Eyelid cancer is broadly categorized as an epithelial tumor, meaning it is on the outer surface. About 90 percent of all eyelid cancers are basal cell carcinoma skin cancer. When you consider the amount of sun exposure that the eyelids receive, it’s not surprising that skin cancer is prevalent here.
- Basal cell carcinoma — Located under the squamous cells in the lower epidermis are round cells known as basal cells. Around 80 percent of all skin cancers come from this layer in the skin. Basal cell carcinomas most commonly start on the lower eyelid as pearly elevated bumps that bleed easily. It usually grows slowly but can eventually destroy the eyelids and eye.
- Squamous cell carcinoma — This skin cancer forms on the top layer of the epidermis, which consists of mainly squamous cells. It is far less common than basal cell carcinoma, but grows more aggressively and can spread to nearby tissues. It may start in a pre-cancerous form, called actinic keratosis, that appears as a scaly red patch that won’t seem to heal.
- Sebaceous carcinoma — The third most common eyelid cancer, sebaceous carcinoma occurs mostly in middle aged or older adults. It usually starts in the meibomian glands, that make an oil that lubricates the eyes and prevents evaporation of the tears. This aggressive tumor often occurs on the upper eyelid where there are more glands.
- Melanoma – Fortunately this dangerous tumor is very uncommon on the eyelids. It can begin as a brown or pale mass, and if left untreated, it can spread through the bloodstream to other body parts.
Treatment options for eyelid tumors
At Fante Eye & Face Centre, we use a variety of options to treat eyelid tumors, whether cancerous or benign. We usually start with a biopsy to determine the type of tumor. Based on this information, most benign tumors will require no other treatment, whereas cancers are usually completely removed.
- Biopsy — When a tumor is biopsied to find out if it is cancerous, it can be either incisional (taking part of the tumor) or excisional (taking the entire tumor). If the growth turns out to be benign, excisional biopsy may be all that’s needed.
- Mohs or Frozen Section surgery — Mohs surgery is used whenever possible due to the delicate characteristics of the eyelids. When using these techniques, the surgeon or dermatologist will remove the visible eyelid cancer, along with fragments of the healthy skin at the tumor edge. This edge tissue is then immediately examined under a microscope to see if still contains any cancer cells. If cancer cells are still present, an additional ring of tissue is removed until cancerous cells no longer are present. Once the cancer is gone, reconstruction can be performed to restore the best possible function and appearance.
- Cryosurgery — While this isn’t surgery involving a scalpel, cryosurgery can be an effective method of removing cancers or pre-cancers without removing additional tissue. Cryosurgery uses liquid nitrogen to freeze and kill cancer cells. The frozen cells and skin blister and peel off and reconstruction is usually not needed. The process is simpler than Mohs or Frozen Section surgery, but the success rate is not as high.
- Radiation and Chemotherapy – These treatments are usually not the best single therapy for cancers of the eyelids, but sometimes are part of the treatment for advanced or complex tumors. External beam radiotherapy and drugs such as 5-fluorouracil, aminolevulinic acid, imiquimod, and vismodegib may be recommended to selected patients.
The advantages of Mohs surgery of the eyelids
The team at Fante Eye & Face Centre utilizes Mohs or Frozen Section surgery whenever possible to remove eyelid tumors. This is because this method minimizes the amount of healthy tissue removed in addition to the tumor, and it eliminates the guesswork involved in finding the tumor boundaries. By continually testing the outer edges of the removed tissue for any remaining cancer cells, there is little question when the entire tumor has been removed. That’s why Mohs or Frozen Section surgery has the highest success rate of all surgeries for skin cancer — up to 99 percent. Sometimes the surgery to remove the cancer and any needed reconstruction will be perfomed by the same surgeon, and sometimes the two stages will be performed by different specialists.
Can the tumor return down the road?
If the tumor was benign and only part of it was removed, then of course it can grow back. Depending on the size and appearance, it may or may not make sense to be aggressive about removing a benign tumor since there is usually a small scar created.
Similarly, if some cancer cells have been missed by surgery, the tumor can return. As mentioned above, however, Mohs or Frozen Section surgery has an incredibly high success rate for fully removing the tumor.
Of course, removing one skin cancer from the eyelids doesn’t mean that another, new tumor can’t eventually develop.
Recovery after surgery
Your recovery will depend on the type of reconstructive surgery used. For instance, a direct closure may be used if the amount of tissue removed is not overly large, and then skin stitches would be removed after 7-10 days, while deeper ones would absorb over 6-12 weeks. For more involved tumors, skin grafts and the use of skin flaps attached to blood supply might be necessary. Both of these options require more involved recovery times, and sometimes additional procedures. Because of the delicate nature of the eye area, bruising and a “black eye” are very common and typically will last 1-2 weeks. Antibiotics eyedrops and/or ointments are often prescribed. Temporary eye dryness is common, while pain is uncommon. Mildly blurry vision may occur from ointments but a change in glasses prescription is rarely seen. In the worst cases, it is necessary to temporarily sew the eyelids of one eye closed for a few weeks. Nevertheless, the expertise of Drs. Fante and Hawes will ensure the best possible outcomes with a return of eyelid function and minimal scarring.
Schedule a Consultation
If you are interested in treatment for an eyelid tumor, contact our Denver office today! Call (303) 839-1616 to schedule a consultation with facial plastic surgeon Dr. Robert Fante.