Eyelid skin cancers and Mohs surgery

July 21, 2016

Skin cancers of the eyelids - let’s start with some background.

Skin cancers of the eyelids are more common than most people think, in fact, up to one in ten cases of skin cancers anywhere on the body occur on the eyelids.1 Just like on the rest of the body, several types of skin cancers can form on the eyelids.  The most common skin cancer of the eyelids is basal cell carcinoma, a skin cancer that frequently grows by expanding its borders outward.2 It is common on sun-exposed areas.  On the eyelids, the lower eyelid is the most common place for basal cell carcinomas to occur.3 Other types of skin cancers can form on eyelids too; these include squamous cell carcinoma and sebaceous cell carcinoma, among other rarer cancers.3 

 

Although surgeons can approach eyelid skin cancers with several proven techniques, Mohs surgery is a common and effective way to treat eyelid skin cancers.  In a study published in 2001, surgeons at the Mayo Clinic reported that strong evidence supports using a technique known as Mohs’ micrographic surgery to remove basal cell carcinoma and squamous cell carcinoma from the eyelids.1 Mohs surgery is an ideal approach for these eyelid skin cancers because it does an excellent job of removing the cancer while sparing as much normal tissue as possible. 

 

What is Mohs surgery?

It may help to think of Mohs surgery as a process, rather than a single surgery.  In Mohs surgery, a specialized skin surgeon removes an area around the skin cancer and looks at it under a microscope.  The Mohs surgeon examines the tissue to see if all of the borders of the tissue are clear of cancer.  If all the borders are clear, the surgery is complete.  If not, the Mohs surgeon will remove more tissue in the areas that still have cancer, while avoiding the areas that are already clear of cancer.  The Mohs surgeon then repeats the process until the cancer is fully removed.

 

Why go through a process that requires multiple steps?    

When removing a skin cancer from the eyelids, there are two main goals:  first, remove all of the cancer and second, spare as much healthy eyelid tissue as possible.  Unfortunately, when your Mohs surgeon looks at a skin cancer on the eyelids, they can’t tell if it is the tip of the iceberg – or the entire iceberg.  The advantage of going through the steps of Mohs surgery is that it gives your surgeon a road map for removing the skin cancer while sparing healthy tissue.  The process is similar to removing a weed from your garden.  You could dig a large hole in the garden to make sure you get the weed out, but this would disrupt all the flowers and vegetables that are so important in your garden.  Instead, you could slowly and carefully dig out each of the weed’s roots, following the roots only in the directions they spread.  This allows you to keep as much of the healthy parts of your garden untouched.      

Certainly, there are good alternatives to Mohs surgery, with the main rival being excision with frozen-section control.  Ultimately, this process is very similar in that a small bit of suspicious tissue is removed and then checked for cancer, before removing more tissue.    

 

Why two surgeons?  What does an ophthalmic plastic and reconstructive surgeon add to the process of Mohs surgery? 

After the skin cancer is removed from an eyelid, the next step is to repair the eyelid.  Mohs surgeons are incredibly talented and well-trained surgeons comfortable working all over the body; however, frequently they will partner with an ophthalmic plastic and reconstructive surgeon to repair the eyelid.  This partnership gives patients a unique benefit:  they get the advantage of Mohs surgery to remove the cancer and the benefit of having an eyelid surgery specialist repair the eyelid after the cancer is removed. 

 

In Davenport, Dr. Repp works as an ophthalmic plastic and reconstructive surgeon, partnering with a local Mohs surgeon to serve the Quad Cities.  Together, they offer specialized surgical care to treat skin cancers of the eyelids and surrounding areas of the face.

 

How does the team work together? 

Generally, a patient will have their skin cancer removed with Mohs surgery on one day, and see Dr. Repp the following day for repair and reconstruction.  The repair with Dr. Repp and the Mohs surgery are on different days for several reasons. The main reason is that Mohs surgeons require specialized equipment that they have on hand at their facility; similarly, Dr. Repp needs specialized equipment to repair the eyelid, equipment that is available at the outpatient surgery center where Dr. Repp performs surgery.   


If you have an eyelid bump that you’re concerned about, don’t wait.  Call Dr. Repp’s office at 563.213.5080 to set up a confidential consultation right here in the Quad Cities.    

 

References:

1. Cook BE Jr, Bartley GB.  Treatment options and future prospects for the management of eyelid malignancies: an evidence-based update.  Ophthalmology. 2001 Nov;108(11):2088-98

 

2.  Yen, M.  Surgery of the eyelids, lacrimal system and orbit.  Oxford University Press.  Second edition, 2012. 

 

3.  Orbit, Eyelids and Lacrimal System.  Basic and Clinical Science Course.  American Academy of Ophthalmology, 2010.  

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