Skin cancer often involves the skin of the eyelid or adjacent face. Eyelid skin cancers occur most often on the lower eyelid, but may be found anywhere on the eyelid margins, corners of the eye, eyebrow skin, or adjacent areas of the face. Usually, they appear as painless elevations or nodules. Occasionally, the eyelashes are distorted or missing. There may be ulcerations of the involved area, along with bleeding, crusting, and/or distortion of the normal skin structure. Such findings need to be evaluated and may require a biopsy to confirm the diagnosis of skin cancer. Excessive exposure to sunlight is the single most important factor associated with skin cancers on the face, eyelids, and arms. Fair-skinned people develop skin cancers far more frequently than dark-skinned people. Skin cancers may also be hereditary. The most common types of skin cancers are basal cell carcinoma and squamous cell carcinoma. Both types enlarge locally and usually do not spread (metastasize) to distant parts of the body. However, with time, if not completely removed, either type will invade adjacent structures. It is important to know that basal and squamous cell carcinomas are relatively slow growing. Thus, when detected early and treated in a prompt and appropriate manner, there is a better chance of removing the tumor completely and minimizing the amount of tissue affected by the carcinoma.
Sebaceous gland carcinoma and malignant melanoma are more serious forms of skin cancer because they may spread (metastasize) to other parts of the body. These types of skin cancer require prompt, aggressive treatment because of the threat of early spread.
There are two very important principles in the management of eyelid skin cancers–complete removal and reconstruction. Complete removal of the tumor is critical to minimize the possibility of recurrence, which is even more difficult to manage. The surgeon may remove the tumor and have a pathologist check the tissue margins (“frozen section”) to be sure the tumor is completely removed. Once the tumor has been completely removed, reconstructive surgery by an oculoplastic surgeon is usually necessary.
Occasionally, the wound can heal on its own through aprocess called “granulation”. More commonly, reconstructive surgery is performed to make a new eyelid or repair the defect. Many excellent techniques are available to reconstruct almost any surgical defect. The operation will be specifically tailored to the defect that is present following removal of the tumor. Regardless of technique, the goals remain the same: to reconstruct the eyelid so that it functions properly, protects the eye, preserves vision, and has a satisfactory cosmetic appearance. Any form of therapy for eyelid skin cancer will leave a scar. However, an effort is always made to minimize scarring and obtain optimal cosmetic results. After surgery, the healing process may take six months to one year. Once the wound has healed, routine follow-up is necessary to be sure that the skin cancer does not recur. Should there be development of a new cancer, it can then be detected early and treated promptly.
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