Skin Cancer of the eyelids poses several diagnostic and management challenge. As a referral specialist, I see these patients well after a significant progression has occurred and the diagnosis is fairly obvious. The excision and reconstruction if these tumors requires a great degree of creativity and flexibility to achieve the optimal result.
The ultraviolet radiation that is primarily responsible for malignant transformation of skin cancer are 290 to 320 nm(UV-B). The most common malignancies affecting the periocular region are basal cell carcinoma, squamous cell carcinoma, sebaceous cell carcinoma, and malignant melanoma. Basal cell carcinoma accounts for 90% of all eyelid malignancies. The tumor primarily involves the lower eyelid (50% to 66%) and the medial canthus (25% to 30%). The upper eyelid is affected in 15% of cases and the lateral canthus in 5%. Although these statistics are helpful, many skin cancers involve adjacent anatomic areas such as the forehead and cheek, and pose even greater challenges in reconstruction.
Key factors in the management of periocular basal cell carcinoma and other eyelid malignancies are:
- Recognition
- Awareness of the patients’s visual acuity in each eye and current state of ocular health.
- Possibility of lacrimal drainage system involvement
- Method of excision
- Method of reconstruction
Early detection and diagnosis are critical. Reconstruction of the posterior and anterior lamella of the eyelid can become complicated when the defect is large. We must educate at-risk patients to bring the appearance of any new lesion to the attention of a physician.
Tags: cancer, melanoma, skin cancer, tumor, tumors