Hello, welcome to the case of the day. I’m Dr. Croley, and today we’re gonna discuss a patient who came in with just a recent post-op, and they had a skin cancer or basal cell cancer on the edge of their lower lid. So, right on the edge of the lower lid was a nodule which turned out to be a basal cell carcinoma and so we had to remove that.
We’ll go over the steps of what we do about skin cancers on the lids. Basal cell carcinomas can occur on the skin of your lid, just like it can on any part of your body. The difference is, this is sort of a very critical structure, whereas on your arm, back or somewhere else is not that critical about taking the lesion off; but we’re talking about something to be taken off from your lid, that’s a different story.
Basal carcinomas occur on the lid, maybe 90% of the time on the lower lid versus the upper lid. This area is more exposed to the sun, than the upper lid is, so therefore they occur much more often on the lower lid.
The first thing that we do when we have suspicious lesion on the lower lid is we take a small biopsy to see and make sure that it is skin cancer before we go further about looking at removing that because when it turn out to be benign we would do very minimal treatment to that area and that would be the end of it. But if it comes out as basal cell carcinoma or a squamous cell carcinoma, then we have to do further steps to cure the problem.
So, what has to be done actually is we have to cut all the way through the lid, all the way through your eyelid, and we have to go to the other end of the lesion, and cut all the way to the lid, so we are taking out a pie section, of your eyelid. And we make sure we have margins, that is, all the margins are clear. Typically when we do that, we get ourselves a frozen section, so we send this to the pathologist right away and we make sure that there is no cancer on the edge on any of the incisions before we then finish sewing these back up and repairing the lid. So, once that’s done and we get clear margins, then we sew the lid back to the other, so we approximate these lids, sew the skin up and so we can make someone’s eyelid look pretty much normal, after the surgery’s done.
Now, if it turned out there was not enough laxity in the skin to get the two edges together which doesn’t happen a lot as long as we catch the cancer early and is not very big, because as we age our lids get sort of slack, anyway, and so it’s usually not a problem. But if it did occur that you did not have enough tissue for the lids to meet again, then we will go right here to the lateral canthus of the lid, make an incision, and then pull over some of the skin, so now we can now bring in our flap over, so now we have the laxity to get the ends to meet. And these are just sutured together, the stitches run 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 is a very large cancer, then so sometimes a whole eyelid has to be reconstructed, but that’s done with a much larger procedure, it is not done very often.
So, 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, then you need to go see an eye doctor, and make sure what that is. And if it does look suspicious for a cancer then a biopsy will be done, and if there is a cancer there, that lesion can be removed. Certainly don’t wait around because when they’re smaller they’re pretty easy to take care of, when they get large, the surgery is much, much bigger.
So, if you have any questions about basal cell carcinomas or eyelid cancers, you can always contact us through the website. In fact you can see where I’ve treated my cheek here because I had a little skin poly actinic keratosis, precursor to a skin cancer that I had treated, that way I got rid of the bad cells.
Anyway, if you have any questions about any eyelid lesions or anything as far as that goes just contact us through the website. If not, may God bless you with healthy eyes and great vision.