Most lesions affecting the eyelids are benign and can be removed with a simple biopsy of the eyelid.
There are a number of different malignant tumours that can affect the eyelid. The most common if these is the basal cell carcinoma (BCC) also known as a rodent cell ulcer.
Other types of tumour can affect the eyelid including squamous cell carcinoma (SCC), malignant melanoma, sebaceous cell carcinoma and Merkel cell carcinoma. These tumours are rare and will be discussed with you on a case-by-case basis.
Firstly an eyelid biopsy is performed to ascertain what type of lesion is present. The tissue is reviewed by a pathologist and we can then decide the best treatment plan. In many cases no further treatment is necessary. In cases of tumours such as basal cell carcinoma’ s (BCC’s) of the eyelid, further surgery may be required to ensure that all the cancerous cells have been removed. In some cases we will perform Mohs surgery which is a bespoke technique for removing eyelid tumours.
Mohs surgery is a specialized technique used to remove skin cancer cells from the eyelids. This technique is commonly used to remove BCC’s and is available in Oxford.
A Dermatologist will remove the tissue from the eyelid and examine the specimen for cancer cells while you wait.
The aim of Mohs surgery is to excise the tumour without leaving any tumour behind (see red arrow below) whilst preserving as much tissue as possible for reconstruction.
The tissue excised is mapped using colour codes and each quadrant is examined in very thin slices.
The Mohs Surgeon looks for skin cancer cells present at the border of the excised tissue (1). It this is present he/she knows exactly where to excise more tissue. In this case it is the yellow quadrant that needs further treatment (2). This is a very accurate way of removing skin cancer cells.
The tumour is then further excised leaving no remnant behind that could cause a recurrence and the process is repeated until no tumour cells are seen at the margin.
After the Mohs surgery Mr Norris will reconstruct the eyelid. The aim of reconstruction is to re-build the eyelid to give the best possible cosmetic and functional result. The eyelids serve many functions involved in protecting the eye and maintaining the position of your tear film. The aim of surgery is to preserve these functions whilst making the eyelid appear as normal as possible.
Author: Mr Jonathan Norris FRCOphth