Because the eyelid skin is the thinnest on the body, it is often the first area of the face to show signs of aging. Unfortunately, sun damage and other environmental factors cannot only take a toll on the appearance of the skin, but they can also lead to serious damage.
Skin cancer usually appears on the face or eyelids in the form of painless elevations or nodules. Although eyelid skin cancers may be found anywhere on the eyelids and result in distorted or missing eyelashes, these cancers occur most often on the lower eyelids. Bleeding, crusting, color changes, or distortion of the normal skin structure may also be apparent. Such findings need to be evaluated and may require a biopsy to diagnose whether it is skin cancer.
The most common types of skin cancers are basal cell carcinoma and squamous cell carcinoma. Because these cancers grow slowly over months and years, there is an excellent chance that prompt treatment can result in complete removal of the tumor with only a minimal amount of affected surrounding tissue required to be excised.
Sebaceous gland carcinoma and malignant melanoma are more serious forms of skin cancer because they may spread (metastasize) to other parts of the body more quickly. These types of skin cancer require prompt, aggressive treatment because of the threat of early metastasis.
The two very important principles in the management of eyelid skin cancers are 1) excising the entire malignancy and 2) reconstruction. Complete removal of the tumor is critical to minimize the possibility of recurrences, which are more difficult to manage.
Dr. Cole may remove the tumor and have a pathologist check the tissue margins (frozen section) to be sure the tumor has been completely removed. In another method, a dermatological surgeon excises the tumor in a special way (Mohs technique) to ensure total removal.
Once the tumor has been completely removed, the wound can occasionally heal on its own through a process called granulation. More commonly, however, reconstructive surgery is needed to make a new eyelid or repair the defect.
Many excellent techniques are available to reconstruct almost any surgical defect that is present following the removal of a tumor. Regardless of the technique, the goal remains the same: to reconstruct the eyelid so that it functions properly, protects the eye, preserves vision, and has a satisfactory cosmetic appearance.
After surgery, the healing process may take anywhere from 4 to 12 months. Once the wound has healed, follow-up should be done with Dr. Cole and a dermatologist, if needed, to be sure the skin cancer does not recur. Should a new cancer develop, it can then be detected early and treated promptly.