Eyelid Skin Cancer surgery

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Eyelid Skin Cancer Surgery

Our faces are the most exposed parts of our bodies. Exposure to the sun can result in many changes to our skin, including wrinkles and aging, and in some cases, damage that can cause skin cancers. In fact, the lower eyelid is particularly at risk because it is unprotected by the bony structure of our face. Unlike the upper eyelid, which hides well underneath the brow, the lower eyelid is always exposed to the sun. Additionally, because the eyelid skin is very thin, it is particularly vulnerable to sun-related damage, and is the second most common location for facial skin cancer to form. When a skin cancer is found, care must be taken in treating it because the eyelid has many delicate, unique features including lashes and tear drains. Seeing an eyelid surgery specialist, such as Dr. Dewan, can help you achieve the best end results.

What are the main types of skin cancer seen in the eyelid?

Nearly 90% of skin cancers on the face are a single type called Basal Cell Carcinoma. It, like most skin cancers, forms as a result of cumulative sun damage over many years. The good news about Basal Cell is that it is a slow-growing skin cancer. It does not spread to other parts of the body and typically remains small in size. If it is left untreated, however, over many years, it can grow to a size that can affect your vision or the health of your eye.

The remaining 5-10% of skin cancers are made up of Squamous Cell Carcinoma, Sebaceous Gland Carcinoma, and Melanoma. These skin cancers are more aggressive than Basal Cell, and have a tendency to grow more quickly. They can often be associated with pain and discharge and redness of the eye. Melanoma can also spread to other parts of the body and represents a much more dangerous skin cancer that needs to be treated aggressively.

How are skin cancers treated?

Treating skin cancers is a multiple-step process:

When a new growth is seen on the eyelid, the first step in treatment is to have a consultation. Skin cancers, in most cases, have specific features and appearances associated with their growth. Dr. Dewan will take a thorough history and perform a comprehensive exam of your eyelids. If there is concern of skin cancer, Dr. Dewan will recommend a biopsy of the growth.
A biopsy will be performed on the growth. This is a short procedure where your eyelid will be numbed and a small section of the growth removed. This sample will be sent to a pathologist for diagnosis. In most cases, our office will receive a diagnosis within 1-2 days and then call you with the results.
If a skin cancer is, in fact, diagnosed, the most common treatment is surgical removal of the skin cancer.

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How is surgery for skin cancer performed?

There are two surgical options for removal of a skin cancer. When we think about surgery for skin cancers, we separate the surgery into two parts. First, the skin cancer has to be removed. This involves removing the visible growth, and then taking small samples around the growth called margins. The margins are examined under a microscope to ensure that no skin cancer is present, meaning that all the skin cancer was removed. If there are areas where skin cancer is still present, more skin is removed from those areas and then re-examined. This process continues until all the skin cancer is removed. This removal process can be performed by Dr. Dewan in the operating room with the assistance of a pathologist. Alternatively, Dr. Dewan frequently works with specialized dermatologists called Mohs Surgeons. They perform the surgery in their own offices.

The second stage is called reconstruction. Once the skin cancer has been removed, the skin and eyelid needs to be repaired so that the eyelid looks good and functions normally. As a specialist in eyelid surgery, Dr. Dewan uses a variety of techniques to give you the best cosmetic and functional result. This reconstruction may be performed at the same time as the removal of the cancer if Dr. Dewan is performing the surgery in the operating room. If a Mohs surgeon did the removal, Dr. Dewan repairs the eyelid in his office or operating room within 1-2 days of the removal.

What is the recovery like from a skin cancer removal?

After a skin cancer is removed, in most cases, a patch is placed over your eye. This patch is typically left in place for 1 day. We recommend using ice packs over the patch, and then continuing the ice packs over the eye after the patch is removed. Dr. Dewan prescribes an antibiotic ointment for you to use on all the stitches that are placed during your surgery. Pain is usually minimal and most patients treat it with either Tylenol or ibuprofen. Patients are free to shower and do most activities within 1-2 days. Any bruising or swelling present will improve over 10-12 days, during which time the stitches dissolve on their own.

Does insurance cover skin cancer removal?

Skin cancer removal is a medical procedure that is covered by insurance. After your consultation with Dr. Dewan, our office will confirm coverage with your insurance company. If a prior-authorization is required, we will initiate the process on your behalf. We will also obtain an estimate for any out-of-pocket expenses you may be responsible for.

How do I prevent future skin cancers?

While some patients are more prone to skin cancers than others, sun damage is the main culprit in the formation of skin cancers. It is important to understand that the sun damage is cumulative over your lifetime. That means that the best preventive method is to protect your skin with a combination of sunscreen, sunglasses, and hats. It is also important to remember that in Minnesota, winter is the sunniest time of the year. We are exposed to a significant amount of sun in the winter, especially because sunlight reflects off the snow and ice. We often forget that this winter sun is damaging as well, so even in the winter you should apply sunscreen. We do recommend using an eyelid specific sunscreen for the best protection and are happy to discuss this during your consultation.

Before and After

The following pictures show skin cancers after they have been removed and repaired.

before and after 20 — This patient is 42 years old and had this lower eyelid growth for many months. It had regrown every time she picked at it and ultimately had it biopsied. It turned out to be basal cell carcinoma. She had a Mohs procedure with a dermatologist, leaving her with a large excision area. Dr. Dewan repaired her lid using a flap closure technique. The post-operative picture was 1 week after surgery.

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