If a lesion is suspicious for malignancy, Dr. Hellman will perform a biopsy to determine if it is cancerous. Depending on the results, he may refer you to a Mohs surgeon, a dermatologist who specializes in the removal of skin cancers. The Mohs surgeon will remove the tumor in multiple stages to ensure that all of the malignant tissue has been removed. Dr. Hellman will then perform reconstruction of the eyelid. Reconstruction involves either some sort of tissue rearrangement or a skin graft to fill the area where the skin cancer was. Skin grafts use skin from your upper lid, behind your ear, or from your neck to replace the missing skin. When large portions of the eyelid are missing, Dr. Hellman may take tissue from another eyelid to create a new eyelid.
Skin Cancers
The most common type of eyelid skin cancer is a basal cell carcinoma. More than 90% of eyelid skin cancers are basal cell carcinoma. There is often an ulcerated center with raised edges and tiny vessels on it called telangiectasias.
The next most common form of eyelid skin cancer is squamous cell carcinoma. These are more aggressive than basal cell carcinomas and are more likely to spread to lymph nodes or even to distant locations in the body.
Malignant melanoma is not common on the eyelid and makes up less than 1% of all eyelid skin cancers. These tumors can also metastasize to other organs so identifying and treating them early is important.
Sebaceous carcinoma is another very rare eyelid tumor known as the great masquerader due to its variable presentation. If a stye or chalazion is persistent despite treatment it is a good idea to take a biopsy to rule out sebaceous carcinoma.
Before (Top) & After (Bottom)
