Meet Dr. Mpopi Lenake, ophthalmologist and oculoplastic surgeon. She is one of the reconstructive surgeons who works closely with Dr. Johann de Wet in the Somerset West branch of the Skinmatters Mohs and Reconstructive Unit at the Summerhill Surgical Centre. In our latest blog post she shares her views on Mohs surgery for eyelid cancers.
“The goals of eyelid reconstruction after skin cancer excision include restoring eyelid structure and function while attaining acceptable aesthetic results. Mohs surgery achieves high cure rates while preserving healthy tissue, making it a useful technique for removal of skin cancers around the eyelids, where small amounts of tissue excision may involve important structures that affect the normal function of the eyelids.
It is also helpful in removing squamous cell carcinomas or morphea-form basal carcinomas, which are notorious for their extensive microscopic spread, well beyond the clinically apparent margins. Recurrent tumours and those involving the canthi (medial canthus specifically) are particularly challenging as they can spread into the orbit. Mohs is especially useful here.
Another advantage of working with a Mohs surgeon is that the excising and the reconstructing surgeons are different people. If a reconstructive surgeon is available, the Mohs surgeon has no hesitation in performing one more excision that might make the defect more difficult to reconstruct. A surgeon performing both the tumour excision and reconstruction may subconsciously hesitate to do this. This division of labour results in the best benefit for patients.
“I am very excited to know that there is a service that is now available to patients with periocular skin cancer that will result in higher cure rates while preserving their eyelids”.
Read more about Dr. Lenake.
REMOVAL OF EYELID SKIN CANCER
Mohs surgery is an effective treatment for eyelid cancers due to several reasons:
First and foremost, the eyelids are a delicate and complex area of the face with a complex anatomy that requires precision and expertise to treat effectively. Mohs surgery, with its meticulous approach, allows for the preservation of healthy tissue and the removal of cancerous tissue with maximum precision, which is especially crucial in the eyelid area.
Secondly, the eyelids have a high cosmetic value, and any treatment that alters their appearance can have significant psychological effects on the patient. Mohs surgery offers an optimal cosmetic outcome because it only removes the cancerous tissue and preserves as much healthy tissue as possible, which helps to maintain the natural look of the eyelid.
Lastly, eyelid cancers have a high risk of recurrence, and complete removal of all cancerous tissue is crucial for successful treatment. The Mohs surgery technique allows the surgeon to examine the entire surgical margin under the microscope in real-time, ensuring that all cancer cells have been removed before the wound is closed.
Overall, Mohs surgery is a highly effective treatment for eyelid cancers because of its precision, cosmetic outcomes, and high cure rates. It is a preferred treatment option for eyelid cancers, especially those located in challenging areas, such as the medial canthus or eyelid margin, where it can be challenging to remove all cancerous tissue while preserving healthy tissue.
Also read about Dr Johann de Wet’s presentation on Mohs Micrographic Surgery for eyelid skin cancers.
WHAT IS EYELID SKIN CANCER?
Eyelid skin cancer, also known as eyelid carcinoma, is a type of cancer that develops on the skin of the eyelids. It is most commonly caused by excessive exposure to ultraviolet (UV) radiation from the sun over an extended period. UV radiation can damage the DNA in skin cells, leading to the uncontrolled growth of abnormal cells and the development of cancer.
WHAT ARE THE DIFFERENT TYPES EYELID SKIN CANCER?
There are different types of skin cancer that can occur on the eyelids, with the most common being basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and melanoma.
1. Basal Cell Carcinoma (BCC): BCC is the most frequent type of eyelid skin cancer. It usually appears as a small, raised, pearly bump with visible blood vessels. It may ulcerate and crust over but is typically slow-growing and rarely spreads to other parts of the body (metastasizes).
2. Squamous Cell Carcinoma (SCC): SCC is less common on the eyelids than BCC but is more aggressive. It often presents as a scaly, red patch or a rapidly growing nodule. SCC can metastasize to regional lymph nodes if not treated early.
3. Melanoma: Melanoma is the most dangerous form of skin cancer and can develop on the eyelids as well. It typically appears as a dark, irregularly shaped lesion or a pigmented patch. Melanoma has a higher risk of metastasizing to other parts of the body, making early detection and treatment crucial.
WHAT ARE EYELID SKIN CANCER SYMPTOMS?
Eyelid skin cancer can cause symptoms such as itching, pain, tenderness, and changes in eyelid appearance. If you notice any unusual changes or growths on your eyelids, it is essential to seek medical attention promptly. An ophthalmologist or dermatologist can perform a thorough examination and may perform a biopsy to determine if the lesion is cancerous.
IS THERE TREATMENT FOR EYELID SKIN CANCERS?
Treatment for eyelid skin cancer depends on the type, size, and stage of the tumor. Surgical excision is the primary treatment for most cases. In more advanced cases or those with aggressive tumors, additional treatments like radiation therapy or Mohs surgery may be required. Early detection and treatment offer the best chance of successful outcomes and minimize the risk of complications. It’s also essential to protect your eyes and skin from excessive sun exposure by wearing sunglasses, wide-brimmed hats, and using sunscreen with high SPF.