Eyelid Cancer/MOHS Reconstruction
Eyelid Cancer Surgery – Eyelid Reconstruction After Cancer Removal – MOHS Eyelid Reconstruction See the Gallery
About five to ten percent of all skin cancers occur on the eyelids. The vast majority of eyelid cancers are basal cell carcinomas (90%), followed far behind by squamous cell carcinoma (5%), and melanoma (1-2%). Other rare eyelid cancers include sebaceous cell carcinoma and Merkel cell tumors. Due to the delicate tissue, complex anatomy, and intricate function of the eyelids, an expert in eyelid reconstructive surgery should treat cancer in this are. Oculoplastic surgeons are experts at eyelid cancer surgery.
Commonly asked questions
What are the risk factors for developing eyelid cancer?
Since the majority of eyelid cancers are skin cancers, sun exposure is the biggest risk factor. Ultraviolet light (UVA and UVB) can damage skin cells and eventually lead to cancer. People with fair skin, light blue or green eyes, and red or blond hair are at highest risk for developing eyelid cancer after sun exposure. Some rare risk factors include radiation exposure, certain inflammatory skin conditions, a weak immune system, and arsenic exposure. Rare tumors, such as sebaceous cell carcinoma, which are not due to sun exposure, do not share these risk factors.
What are the types of eyelid cancer?
There are many types of eyelid cancer, but most are forms of skin cancer. Basal cell carcinoma is bar far the most common eyelid cancer (90%), followed by squamous cell carcinoma (5%), and melanoma (1-2%). Sebaceous cell carcinoma is not a type of skin cancer. It arises from the oil producing glands of the eyelid margin. There are even more rare types of eyelid cancer including Merkel cell tumors and hair shaft tumors.
What is the treatment for eyelid cancer?
Treatment depends on the type of cancer, so a biopsy should be performed on any suspicious lesion to determine the cell type. Once the cell type is determined, then treatment options are discussed.
Basal cell carcinoma is treated by complete removal and reconstruction of the resultant defect. An oculoplastic surgeon can perform this alone or in conjunction with a dermatologist that specializes in MOHS surgery. Squamous cell carcinoma is generally treated the same way. Since squamous cell carcinoma can be more aggressive, sometimes a larger area of tissue is removed prior to reconstruction.
Eyelid melanoma is a more aggressive tumor that is treated differently. A whole body evaluation (usually by an oncologist) should be performed. In some cases, a sentinel lymph node biopsy may be beneficial. Melanomas need to be removed with wide excision. Usually melanoma is removed in stages and MOHS surgery is not performed. Reconstruction is performed only when it is confirmed that no residual melanoma cells are left
Sebaceous cell carcinoma is also a more aggressive type eyelid cancer. Multiple biopsies are taken to determine the extent of the tumor. Wide excision is preferred for removal. The resultant defect can be reconstructed after margins are clear. A whole body evaluation by an oncologist should also be performed.
What is MOHS surgery/ MOHS reconstruction? Why is it important for eyelid cancer?
MOHS surgery and reconstruction is a special way of removing eyelid skin cancers that has a very high cure rate. It is typically a multi-specialty technique. A MOHS trained dermatologist removes the cancer in “levels” of tissue. These levels of tissue are then processed and analyzed under a microscope by the dermatologist to ensure that all of the cancer cells have been removed. This process is repeated until all of the “margins” are “clear”, meaning the cancer has been totally removed. The resultant defect is then patched, and then the patient is sent over to Dr. Vidor for eyelid reconstruction. Typically the reconstruction is performed within 24 hours.
Eyelid MOHS surgery and reconstruction has several advantages. First and foremost, MOHS surgery for eyelid skin cancer has extremely high cure rates. Basal cell and squamous cell carcinomas are cured in 99% and 98% of cases respectively. Also, because the eyelid anatomy is very complex, even small eyelid defects may require advanced reconstruction techniques. MOHS eyelid surgery removes tissue in individual “levels”, so the defect created is small. MOHS surgery is also preferred for recurrent tumors, or tumors where the edges are difficult to identify.
Where is eyelid MOHS surgery and reconstruction performed and what type of anesthesia is used?
There are two parts to eyelid MOHS procedures- excision and reconstruction. MOHS excision is performed by a dermatologist and is typically done in the office under local anesthesia. MOHS reconstruction is performed by Dr. Vidor and is typically done in the operating room. Depending on the size of the defect, either twilight (MAC) or general anesthesia can be used. Occasionally Dr. Vidor can perform MOHS reconstruction in the office under local anesthesia.
What are the other options for eyelid skin cancer treatment?
MOHS surgery and reconstruction is preferred for the vast majority of eyelid skin cancers. A procedure called “excision with frozen sections” is very similar to MOHS and has cure rates that approach conventional eyelid MOHS surgery. This procedure involves usually involves the use of an outside laboratory. Certain types of eyelid cancer require this type of surgery. A similar procedure call “excision with permanent sections” can be performed, but the entire process can take several days. This technique is typically reserved for treatment of eyelid melanoma. Removal of an eyelid tumor without checking margins has a lower cure rate and is not generally performed.
Non-surgical treatments for eyelid cancer include radiation and chemotherapy. Since most eyelid cancer can be cured by excision alone, radiation and chemotherapy are usually reserved for very special circumstances. Radiation and/or chemotherapy are almost never recommended for isolated primary basal cell or squamous cell carcinoma.
Are there types of eyelid cancer that cannot be treated by MOHS surgery?
There are a few, but they are rare. Historically, eyelid melanoma was not treated with MOHS surgery. However, recent advances in tissue staining and analysis now allow MOHS to be performed in some cases. Eyelid tumors that are very advanced and invade into the orbital fat (the fat of the eye socket) or into bone may require additional surgery beyond a typical MOHS procedure. MOHS surgery may not be an option for certain rare eyelid tumors.