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Skin Cancer

What is eyelid and peri-ocular skin cancer?

Skin cancers can affect the eyelids or peri-ocular region of the face. Eyelid skin cancers most frequently appear on the lower lid, although can be found anywhere on the eyelid, corner of the eye, eyebrow skin and certain areas of the face. Skin cancer usually appears as painless elevations or nodules, often with a pearly appearance, with either loss or distortion of the eyelashes, or fine hairs of the skin. There may be ulceration of the involved area, with bleeding, crusting, redness and/or distortion of normal skin appearance. A biopsy is required to confirm the diagnosis of skin cancer.

What are the common eyelid and peri-ocular skin cancers?

The most common type of skin cancer is the basal cell carcinoma or rodent ulcer, followed less commonly by squamous cell carcinoma. There are other rarer cancers which may also occur, affecting different parts of the skin micro-structure. Basal cell carcinoma and squamous cell carcinoma both enlarge locally and do not usually spread or metastasise to distant parts of the body. However, with time, if these tumours are not completely removed, either type will invade adjacent structures and a squamous cell carcinoma may spread to lymph nodes in the head and neck.

It is important to know that these two types of skin cancer are relatively slow growing, but do require treatment to eradicate them. Tumours must be completely removed, therefore early detection followed by prompt treatment is extremely important.

What are the early warning signs?

If a skin lesion or sore develops and fails to heal within four to six weeks medical advice should be obtained, particularly if two or more of the following features are present:

  • Painless lump in the skin which can appear smooth or have an open sore or ulcer, bleed or crust, and does not heal
  • Red patch on the skin which is itchy, painful or crusty, or may have no symptoms, but the lesion fails to heal or fade
  • Smooth raised growth with an ulcer in the centre, which can be flesh coloured, pink, shiny, red or pigmented like a mole
  • Firm nodule on the skin which can be flesh coloured, pink, shiny, red or pigmented like a mole
  • Small elevation that looks like a flat scarred area on the skin, which is pale, or white, compared to the surrounding skin, and may have an ulcer or an indentation in the centre. This form of BCC can grow more quickly, making the affected skin look taught and shiny

What happens at surgery?

There are two very important principles in the management of eyelid and peri-ocular skin cancers:

  • Complete removal
  • Delicate peri-ocular and eyelid reconstruction

Complete removal of the tumour is critical to minimise the possibility of recurrence. The tumour should be removed with as little normal tissue surround as possible, but enough to ensure safe and complete removal of the tumour and to minimise the possibility of recurrence as this can be very difficult to manage.

Once the tumour has been completely removed and there is microscopic confirmation that no tumour cells remain, reconstructive surgery is usually necessary. Occasionally the wound can be left to heal on its own by a process called granulation, or laissez-faire. Most commonly, reconstructive surgery is performed to make a new eyelid or repair the defect.

A specialised technique called Mohs’ Micrographic Surgery can be utilised in the removal of cell carcinoma skin cancers. In such cases the oculoplastic surgeon will work closely with a surgical dermatologist who will remove the tumour, using a special technique, ensuring that the tumour is completely removed. The oculoplastic surgeon will then perform reconstructive surgery using oculoplastic techniques, such as flaps and skin grafts.

Precautions for future protection from skin cancers?

Following the occurrence of a skin cancer, it is likely that patients may develop others over forthcoming years, on sun exposed parts of the face, neck, shoulders and hands.

As a precaution, the following extra care should be taken:

  • Examine skin every 6 to 12 months for early warning signs and look/feel for any skin changes
  • Ask a partner to examine hard to reach areas such as back, neck, ears and scalp. Alternatively, use a mirror to examine these areas
  • If a lump is found and gives cause for concern, seek immediate advice from a GP
  • Wear protective clothing and wide-brimmed hats when outdoors, which will protect the skin which is most at risk
  • Wear 100% UV protective sunglasses, as the skin surrounding the eyes is vulnerable
  • Avoid sunshine during midday hours if possible
  • It is vital to use a high factor sunscreen with an SPF of 15 or 30. Sunscreen should be applied before sun exposure, and re-applied every 2 to 3 hours, or more frequently if perspiring or swimming
  • Advise others, especially family and friends, to protect themselves from the sun
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Reba Cosmetic Clinic

Spire Cheshire Hospital, Stretton, Warrington, Cheshire WA4 4LU

Appointments call: 01925 215068