The eyelid skin is the thinnest and most sensitive skin on your body. As a result, this is often the first area on your face to show change from sun damage and aging. Unfortunately, sun damage and other environmental toxins not only cause the skin to age but can cause serious damage. Skin cancer of the eyelids is relatively common and several types exist. The presence of a nodule or lesion on the eyelid that grows, bleed or ulcerates should be evaluated. This involves examination and sometimes a biopsy.
Basal Cell Carcinoma
Basal cell tumors represent the ninety percent of eyelid tumors. These skin cancers grow slowly over months and years. They most often appear as a pearly nodule that eventually starts to break down and ulcerate. Despite being a cancer, these tumors don’t spread to distant areas but rather just continue to grow and infiltrate the surrounding tissue. They typically can be cured by simple excision followed by reconstruction of the defect left behind after the tumor removal.
Squamous Cell Carcinoma and Melanoma
These types of tumors occur much less common but are more aggressive and require more involved care to ensure complete treatment. Again, primary treatment involves removing the tumor, but care must also be taken to ensure the tumor has not spread anywhere, causing larger health problems. Your surgeon will help coordinate this as part of your treatment depending on the size and circumstances of the tumor at presentation.
Tumor Excision and Eyelid Reconstruction
Skin cancer needs to be removed surgically by a skilled individual who can not only remove the tumor but reconstruct the eyelid or area where the tumor was removed. Sometimes surgeon will do this themselves at a surgical facility with an on site pathologist who can immediately examine the specimen to ensure the whole tumor was removed. Other times, the help of a dermatologic surgeon specializing in Mohs surgical excision will be utilized. This procedure is completed into two steps, the first in the dermatologist’s office with immediate examination of the tumor to ensure its complete removal followed by the reconstructive surgery by your surgeon.
Eyelid reconstruction may be undertaken in a variety of situations. Defects in the eyelid may arise form a variety of situations, but most commonly after trauma or tumor excision. Simple superficial defects in the eyelid may occur after minor trauma or removal of small growths. Many of these require nothing more than local wound care and will heal on their own in a week to 10 days. Some simple superficial defects may require a few sutures with the same local wound care.
In some instances, such as after traumatic injuries or removal of larger growths or skin cancers, larger defects may extend through the entire lid. Many of these can be sutured together directly, but many others may require more complex reconstructions. In many of these more complex cases, the surgeon will need to use transfer of adjacent tissues (what we call ”flaps”), or transfer of skin from other parts of the eyelid face or body (what we call “skin grafts”) to complete the reconstruction. Some of these more complex reconstructions may require more than one operation to complete (what we call “staged reconstruction”).
Why should you choose Dr. Amadi as your reconstructive surgeon?
Dr. Amadi is an ASOPRS trained surgeon and member, and is a Board certified Oculoplastics surgeon who is not only well trained and experienced in eyelid reconstruction, but are also trained and experienced in the function of the eyelids as the primary protection of the eyeball. Dr Amadi is well versed in the intricacies of the eyelid anatomy and the pitfalls associated with reconstructing this area. Not only does he perform the most complex eyelid reconstructions at his private office and Harborview Medical Center, he is also the Co-Director of the University of Washington Oculofacial Plastic and Orbital Surgery Fellowship at Harborview Center, and is responsible for training/teaching medical students, residents and fellows in the anatomy and surgery of this region.