Dr n. med. Arkadiusz Pogrzebielski
What is it?
Eyelids' tumors are skin cancers that can be both benign or malignant. The appearance of any tumors of the eyelid should urge visits to a specialist. Moreover, recurrent lesions in the place that has already been treated should not be underestimated. Malicious nature of a skin tumor may be indicated by:
- formation of pustules,
- extraction of secretion from the tumor,
- irregular colouration,
- lifting the edges resembling pearl mass,
- presence of small vessels within the tumor,
- damage of eyelid rim caused by the tumor,
- loss of eyelashes in the vicinity of the tumor.
The initial diagnosis is performed using a slit lamp. However, in many cases, clinical examination is not sufficient to make a definitive diagnosis, as skin lesions often have similar macroscopic appearance, despite different histopathological origin. For that reason, a biopsy of a lesion is performed. Biopsy combined with complete removal of lesion gives the answer to the question of the nature of the tumor and simultaneously ensures the removal of cancerous cells. Typically, small tumors located far away from the lacrimal point, external angle tumors and tumors not affecting eyelid's rim or located in their centre qualify for biopsy.
Surgical excision is the treatment of choice in every case of basal cell carcinoma, squamous cell carcinoma with precancerous lesions and melanoma. It offers the greatest chance of full recovery and absence of recurrences. It allows to obtain better cosmetic results and provides faster recovery.
This procedure can be performed in two ways:
- excision of the tumor and removal of strips with a thickness of 1-2 mm from the surrounding tissue, until a clean operating margins i.e. strips with no cancerous cells are obtained;
- tumor excision with wide margins of the surrounding tissues, which is used when tumors are located in the area of the medial angle, as well as in the vertical strip of the central part of the face, where there is the greatest risk of deep tissue infiltration.
Reconstruction of the place from which the tumor has been removed is performed after the surgery. It should be done quickly, but before this a histopathological examination should be carried out, to make sure that the cancer was excised in its entirety. If the defects are small and located in the area of the medial angle, than the tissue can be left to heal spontaneously (granulation), which also renders good cosmetic results, but requires long months of healing.
For larger defects, which usually encompass much bigger area of the eyelid than just the visible tumor, a reconstruction treatment is necessary. For the tissue reconstruction of the defects of full thickness of the eyelid the following rules are applied:
- for small defects (up to 1/3 of the length of the eyelash rim of the lid) - a direct, simple stitching of tissues is done;
- for larger defects with flaccid skin lateral canthal tendons are cut (lateral cantholysis), especially when the defect is located in the central or external part of the eyelid;
- for extensive defects different operating techniques are applied simultaneously and, for example, a skin flap and free tissue transplantation are performed. It is recommended for such procedures to use methods, in which Tenzel flap, Mustarde flap, Hughes flap or Cutler-Beard bridge flap are used. The last two techniques are carried out in two stages - in the second phase, after about 3 weeks, stitched eyelids are released;
After the treatment a dressing and an antibiotic ointment are applied. Skin sutures are removed after 7-10 days, and absorbable ones are left until they self absorb. Patients with malignant tumors require regular follow-up examinations for at least 5 years after the surgery.