Eyelid Cancer Reconstruction

Introduction

Cancer can affect any part of the body, and therefore it can also involve the face or the eyelids. Skin cancers involving the eyelid are unique in many ways. In general, they are not life threatening, and get detected in an early stage since they are easily visible. Their removal and subsequent reconstruction of the eyelid is a highly specialized field, and hence you need to consult an Oculoplastic surgeon, and not just an 'Oncologist'. An Ophthalmology background is a must for successful treatment of skin cancers around the eye.

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.

Types of Skin Cancers

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

Treatment

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 eyelid or 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 used to reconstruct the defects.  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 45 min-1 hour 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

Before and After Photos