Eyelid Skin Cancer

How common is eyelid skin cancer?

Eyelid skin cancer is a very common skin cancer that we see in Australia. Approximately 5-10% of all skin cancers occur in the eyelid

Which is the commonest type of eyelid skin cancer?

The most common type of skin cancer is Basal Cell Carcinoma (BCC), followed by squamous cell carcinoma, sebaceous cell carcinoma and melanoma.

Why is eyelid skin cancer called the ‘great masquerade”?

Eyelid skin cancer can present in more than many ways and early skin cancers can be very subtle. Unlike other parts of the face where skin cancer has typical appearances, in the eyelid they present in many atypical ways as well. Hence it is important to confirm the diagnosis of each and every lesion on the eyelid. Eyelid cancer can present in the following ways a small lump, a bleeding ulcer, a small red patch, loss of eyelashes, minor skin changes and scarring of the skin, swelling of the skin, thickening of the skin.

What is the best way to confirm the diagnosis of a skin cancer on the eyelid?

A biopsy is the best way to confirm the diagnosis of a skin cancer.

What is the next step once you are diagnosed with skin cancer of your eyelid?

Don’t delay your treatment. The quicker you remove an eyelid cancer the smaller the defect that needs to be reconstructed. With a smaller defect to reconstruct, the treatment is successful, and the function and aesthetics of the eyelid can be maintained. 

What is the gold standard treatment of eyelid skin cancer?

1. Complete surgical removal of the cancer
2. Meticulous reconstruction to restore function and aesthetics of the eyelid

Why is it important to have excellent reconstruction of the eyelid following skin cancer removal?

The eyelid is probably the only facial structure that has to function perfectly after reconstruction. In addition, since the eyes are the focus of the face the reconstruction should be aesthetically pleasing to allow the patient to socially integrate back into the community easily.

Who is at risk for recurrence of eyelid skin cancer?

The main reason for recurrence is incomplete removal of the tumour. So, it is important to get it right at the start by an experienced Plastic Surgeon.

How can you ensure that ‘you have got it all’?

We have a pathologist attend the operation and microscopically analyse the tumour once it is removed. Only when the pathologist says it is all clear, we proceed with the reconstruction. This way we can ensure that the cancer has been completely removed and nothing has been left behind. This is not only reassuring to the patient but also to the surgeon.

What are the methods to reconstruct the eyelid?

There are numerous plastic surgery techniques that can give excellent results and restore the function and aesthetics of the eyelid. Various forms of flap reconstructions, canthoplasty, canthopexy and skin grafts are used.

How long does the surgery take and is it done in a Hospital?

The eyelid reconstruction surgery can take 1.5 to 2 hours depending on the complexity. The surgery is performed in a hospital under anaesthetic for your safety and comfort.

Is it day surgery or do I stay overnight?

Most eyelid reconstructions are done as Day Surgery cases. Occasionally complex eyelid reconstruction may require additional hospital stay.

What am I expected to do after the surgery?

1. Lubricating eyedrops to the eye every 2- 4 hours
2. Ice pack cold compress to reduce the swelling
3. Antibiotic ointment to the suture line three times a day for a week
4. Keep the area clean and dry
5. Light activities only for the first week.

What happens at the first post-operative visit?

1. Usually your first post-operative visit is a week after surgery. 
2. The wound and the flap will be inspected to ensure it is healing well and there are no signs of infection. 
3. The eyelid function will be evaluated to ensure the eyelid can close and protect the eye.
4. The sutures are removed, and you will be advised to continue antibiotic ointment for another week. 
5. Your formal pathology report will be discussed.

Will I need additional treatment?

Your formal pathology report will confirm the type of cancer, has it been completely removed, is there spread into the nerves or lymphatics or are there any other suspicious findings. 

If the cancer has been inadequately removed, you will need additional surgery. If the cancer shows signs of spread to the nerves and lymphatics you may need radiation therapy, for which you will be referred on to a specialist radiation cancer specialist.

Will the scars be bad and how long is the healing process?

Typically, the healing process can take up to two weeks. It is important that you follow all the post-operative instructions. You may get the wound wet after 1-2 weeks but going under water is not advisable for 4 weeks.

Scars on the eyelid heal very well. It is normal for the scar to be visible for the first 3-6 months it will continue to fade and by 12-18 months you can expect good resolution of the scars. If appropriate scar treatment using silicone gel is recommended.