Eyelid Cancers
Eyelid malignancies are about 10% of all skin cancers. They
are all the result of long term ultraviolet sun damage in fair-skinned individuals.
There are 4 types of eye lid cancers.
BCC is the commonest (14 in 100,000) commonly called Rodent
ulcer. The next common skin cancer is squamous cell carcinoma
(1.37 per 100,000) followed by Sebacious gland carcinoma and
melanoma (0.08 in 100,000).
Your surgeon might suggest to obtain a small biopsy prior to
planning to remove the whole lesion.
The main goal in treatment of eyelid cancers is to remove the
tumour completely and at the same time to preserve as much
normal tissue as possible. Any of following plans will allow
this
Frozen section control: The tumour will be removed under local
anaesthesia and will be orientated and mapped. The eye will be
padded and the specimen will be send to histopathology
department. You will be asked to wait in the recovery room. The
pathologist will tell your surgeon if the margin are clear of
tumour. If tumour is still present you will be brought back in
theatre and another small margin is removed until the report is
all clear. The defect will then be repaired. This could be
either under local or general anaesthesia according to your
preference and size of the defect.
The recurrence rate with this procedure in our experience is 0%
over 5 years.
MOHS
You will see a dermatologist with special skills in surgery (Dr
Mohsin Ali in Amersham Hospital )who will remove the tumour under
local anesthesia and will look at the specimen under microscope.
Once the tumour is removed and margins are clear you will be transferred
to Wycombe hospital for Miss Khooshabeh to repair the defect. As
this procedure involves two doctors working together and also
travelling, it is only considered in special circumstances.
The recurrence rate with MOHS in our institution close to 0%
over 5 years.
Delayed repair (semi-urgent paraffin section) (slow MOHS)
This is reserved for melanoma and some large squamous cell
carcinoma or sebaceous gland carcinoma.
The tumour is removed either by Dr Ali or Miss Khooshabeh under
local anaesthesia and sent to histology. The eye is padded and
you are sent home. Apart from driving and shower you can resume
normal activities.
The pathologist needs at least 24 hours to use special stains
and report on adequacy of excision. You are then brought back to
hospital and defect repaired as necessary.
The rate of recurrence in our institution is close to 0% over 5
years.
After surgery you will need to be followed up in clinic for 3
years. The purpose of this is to look for any recurrence as well
as looking for new lesions as 30% of individuals with BCC of
eyelid can develop another BCC elsewhere. How to prepare for surgery
You will be asked to stop Aspirin for 3 weeks and warfarin
for 2 days before operation if you are taking any. You must
check with your GP to make sure it is safe to do so.
You will also be asked to be fasting for about 6 hours. You can
drink water or tea but no milk up to 2 hours before operation.
This is regardless of whether operation is under local or
general anaesthesia. Wear comfortable clothes. You will be
asked to change to theatre gown and also to remove your
jewellery. Complication of eyelid cancer surgery
- Allergy to cleaning or anaesthetic solution
- Infection (unlikely in eyelids as they have very good blood
supply)
- Your surgeon will do her/his best to reconstruct the defect
using flaps or grafts Occasionally a second operation might be
necessary.
- Recurrence
- Corneal abrasion
Other options
The ultimate treatment is surgery but other options can be
considered.
No action at all: Depending on nature of skin cancer the growth
can be slow or aggressive.
Cryotherapy: this is usually reserved for superficial lesions
and if patient refuses surgery. There is no assurance of
clearance.
Radiotherapy: if patient refuses surgery. There is no
assurance of clearance and radiotherapy can damage the eye.
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