Skin Cancer

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 eyelids or 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 normal skin structure.  Such findings need to be evaluated and may require a biopsy to confirm the diagnosis of skin cancer.

CAUSES OF SKIN CANCER
Excessive exposure to sunlight is the single most important factor associated with skin cancers.  There is also a genetic link in people who develop skin cancers.

TYPES OF SKIN CANCERS
The most common types of skin cancers are basal cell carcinoma and squamous cell carcinoma.  Both types enlarge locally and generally 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 carcinoma are relatively slow growing.  Thus, when detected early and treated in a prompt and appropriate manner, there is an excellent 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 metastasis.

TREATMENT
There are two very important principles in the management of eyelid skin cancers – (1) excising the entire malignancy and (2) reconstruction.  Complete removal of the tumor is critical to minimize the possibility of recurrence, which can be more difficult to manage.  Your doctor may remove the tumor and have a pathologist check the tissue margins (frozen section) to be sure the tumor has been completely removed.  In another method, a dermatological surgeon excises the tumor in a special way ("Moh’s technique”) to ensure total removal.

Once the tumor has been completely removed, reconstructive surgery is usually necessary.  Occasionally, the wound can heal on its own through a process 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 that is present following removal of the tumor.  Regardless of the 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 can leave a scar.  An effort is always made to minimize scarring and obtain optimal cosmetic results.  After surgery, the healing process may take six (6) months to one (1) year.  Once the wound has healed, follow-up should be done with your doctor and a dermatologist if necessary to be sure that the skin cancer does not recur.  Should a new cancer develop, it can then be detected early and treated promptly.