The vast majority of eyelid cancers are due to sun exposure. The most common cancer on the eyelid is basal cell carcinoma, followed by squamous cell carcinoma. Less commonly, melanoma may occur on the eyelid, and may or may not be pigmented.
Basal Cell Carcinoma
Cancers of the eyelid may masquerade as other growths, including styes, chalazia, and moles. Eyelash loss may be seen with some types of cancer, so always deserves attention. The borders of a cancer are sometimes indistinct, making it difficult to determine where the cancer begins and ends.
When there is any question about an eyelid growth, a biopsy is usually performed in the office. The numbing injections for the biopsy may sting, but they usually hurt very little, if at all. Once the eyelid is numb, a thin layer is shaved off the surface of the growth. This is sent to the laboratory for analysis under a microscope. If the biopsy comes back negative (meaning the growth is benign or harmless), no further treatment is necessary and the biopsy site will heal well. If the biopsy comes back positive for cancer or pre-cancer, further treatment is necessary and depends on the type of cancer. In most cases, complete surgical removal is necessary.
Basal Cell Carcinoma with poorly defined borders
(approximate edges of cancer indicated by arrows)
After removal of poorly defined cancer in photo above
After reconstruction and healing
Dr. Lee sends most of his cancer patients to a specialized dermatologist called a Mohs surgeon for cancer removal; the patient is then sent back to Dr. Lee for wound repair in the operating room. Mohs surgeons are experts at removing tumors while sparing as much normal tissue as possible—they accomplish this by taking thin slices of tissue and examining each slice under the microscope until the cancer is completely removed. Thus, Mohs surgeons are able to minimize the defect from cancer removal.
Having a portion of your eyelid removed is certainly a scary prospect, but there are many excellent techniques for reconstructing eyelids. Even after most of an eyelid has been removed, excellent results are possible (see Gallery).
It is sometimes necessary for Dr. Lee to remove the cancer himself, and if so, the specimen is still examined under a microscope by a pathologist to confirm that the cancer has been completely removed.