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A patient came in, recently post-op, and they had a skin cancer, or basal cell cancer, on the edge of their lower lid. There was a nodule that turned out to be a basal cell carcinoma, and we had to remove that. We’ll go over the steps of what we do about skin cancer on the lids.
Basal cell carcinomas can occur on the skin on your lid, just like they can on any other part of the body. The difference is that the eyelid is a very critical structure. It’s not that critical to take a lesion off your arm, back, or somewhere else, but if we’re talking about taking something out of your lid, that’s a different story. Basal cell carcinomas occur about 90% of the time on the lower lid versus the upper lid, because this area is more exposed to the sun than the upper lid.
The first thing we do when we have a suspicious lesion on the lower lid is we take a small biopsy to make sure it’s a skin cancer before we go further about removing it, because if it turns out to be benign, we would do very minimal treatment to that area, and that would be the end of it. However, if it turns out to be a basal cell carcinoma or a squamous cell carcinoma, we have to take further steps to cure the problem.
What has to be done actually is we have to cut all the way through the lid, and then we have to go to the other side of that lesion and cut all the way through the lid, so we’re taking out like a pie section of your eyelid. We make sure we have margins; that is, all the margins are clear, and typically, when we do this, we get what’s called a frozen section. We send this to the pathologist right away, and we make sure that there’s no cancer on the edge of any of the incisions before we finish sewing this back up and repairing the lid. Once that’s done and we get clear margins, we sew the lid one edge back to the other. We approximate these lids and sew the skin up, so we can make someone’s eyelid look pretty much normal after the surgery’s done.
Now, it might turn out that there is not enough laxity in the skin when we get the two edges together. This doesn’t happen a lot as long as we catch the cancer early and it’s not very big, because as we age, our lids get sort of slack anyway, and so it’s usually not a problem. However, if it occurred that you didn’t have enough tissue there to get for the lids to meet again, we would go to the lateral canthus of the lid, make an incision, and then pull over some of the skin. So now we’re bringing a flap over to have enough laxity that we’d actually get the ends to meet, and this is just sutured together. The stitches are in for a couple of weeks, and afterwards the lid can look essentially totally normal, so we can get a great result plus cure the lid of cancer.
On rare occasions, when people have ignored the growth on their lids and it’s a very large cancer, sometimes a whole eyelid has to be reconstructed, but that’s a much larger procedure and is not done very often. If you have a lesion on your upper or lower lid that you’re concerned about and it’s been there only for a short period of time and maybe actually getting a little larger, you need to see an eye doctor and make sure what that is. If it does look suspicious for cancer, then a biopsy will be done, and if there is cancer there, then that lesion can be removed. Don’t wait around because when they’re smaller, they’re pretty easy to take care of.
If you have any questions about basal cell carcinomas or eyelid cancers, you can always contact us through the website. If not, may God bless you with healthy eyes and great vision.
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