Eyelid & Periocular Skin Cancer Reconstruction

Treatment for skin cancer on the eyelids depends on 2 important factors:

1. Histology or type of cancer cells

2. Proximity to the eye

Your initial consultation will involve a biopsy of the suspicious area to determine the type of cells present if this has not been done previously.  Imaging such as an MRI or CT Scan may need to be performed.  If these have been performed treatment options will be discussed.  Generally speaking for early types of Solar keratosis these may be treated with observation or non-surgical options if not too close to the eye. 

Surgery for skin cancer on the eyelid

This is generally performed in a hospital setting however options with uninsured patients can be discussed.

Non-pigmented skin cancer

Including Intraepidermal carcinoma (IEC), Basal cell carcinoma (BCC) and Squamous cell carcinoma (SCC) are generally treated surgically in the periocular area. My preferred method of clearing the tumour is using MOHS Surgery where I partner with some of Brisbane’s leading MOHS Surgeons. This ensures complete clearance of the tumour which leaves as much normal tissue as possible behind.  This is critical in the periocular region. Should MOHS Surgery not be an option I am able to use Frozen Section Margin Control with the help of a team of experienced Ophthalmic pathologists.

Pigmented Skin Cancer

Early stages of Melanoma (Level 1) are now able to be dealt with using MOHS Surgery. This represents a significant step in their excision management.  Should the Melanoma be more advanced than Level 1, traditional wide local excision is employed.

Surgical Reconstruction of the Eyelid

Once the tumour is cleared my attention to reconstructing the defect begins with a thorough re-evaluation of the defect and affected adjacent structures together with your individual circumstances.  My aims are to reconstruct the 2 layers of the eyelid in a manner which creates normal function and achieves an excellent cosmetic result.  Reconstructive options can include local flaps, skin grafts and occasionally require grafts or flaps of specialized eyelid tissue from an adjacent or contralateral eyelid.  I may also reform or repair important structures such as the tear pipes (canaliculus) and tendons and their attachments in the eyelid.  I will discuss in detail at the preoperative appointment and on the day of surgery what type of reconstruction we will be planning to undertake and can modify this depending on your wishes and defect type and size.  The reconstruction is performed under General Anaesthesia.

Non-Surgical Treatment

In some advanced BCC threatening the eye non-surgical options may be discussed.

Adjuvant Treatment

In some advanced cases additional treatment such as Radiotherapy or even Immunotherapy/Molecular pathway modulating agents may be necessary.  I work closely with a team of Radiation and Medical oncologists who are able to deliver these treatments should they be required.

Sutures are generally removed at the post-operative visit at 1 week following surgery.  From there building up of light duties over the next 4 weeks is recommended while the internal sutures dissolve and the wound stabilises and builds up strength.  In some situations a second operation at 4 weeks is required to open the eye again.  Antibiotic and steroid ointments are also used to modify the healing response if required.  Patients are generally able to drive the following day after surgery.

The significant risks relevant to you will be discussed in detail at your consultation.  General risks include recurrence of the tumour, scarring and asymmetry.