The skin on our eyelids is considered the thinnest skin on the human body. Having cancer in the eye area can cause special concern due to the delicate nature of our eyes and the surrounding layers of skin. Skin cancer does occur frequently, however, on the eyelids, sometimes requiring Mohs surgery. Mohs surgery is often followed by the need for reconstruction of varying degrees. The following information discusses the types of reconstructive surgery that can be used on the eyelids and what’s involved in the process.
General Guidelines and Goals in Reconstruction
The type of reconstruction needed will be determined by the size of the defect and where on the eyelid it is located. The age of the patient and the laxity of the skin are also taken into consideration when determining what type of surgery to use. A small defect is generally considered to be less than 30 percent of the eyelid. A medium defect would be in the 30 to 50 percent range, with a large defect covering more than 50 percent of the eyelid area. Reconstructive eyelid surgeons need to be prepared for any size defect though, because even small eyelid cancers can turn into large defects. The goal of reconstructive surgery is for structural and functional restoration of the eyelid. While cosmetic surgery is usually not the primary goal, achieving pleasing aesthetic results is strived for as well. The techniques used for upper and lower eyelids may be slightly different.
Reconstructive Techniques for Smaller Areas
For smaller defects direct closure can often be used to repair the eyelid. Even if defects extend through the entire thickness of the lid, if small enough they can still be sutured closed. The area may be sewn together in layers. Sometimes the surgeon performing the Mohs procedure will be able to complete reconstruction for a small area. However, even for smaller areas it may be recommended to see an oculo-plastic surgeon that specializes in these types of procedures.
Reconstruction for Larger Defects
Reconstructing large areas often involve transferring adjacent tissue or grafts from other parts of the face. These tissues are referred to as flaps. Sometimes skin behind the ear is used as a graft. A large area on the lower lid may require using the Hughes tarsoconjunctival flap procedure. This is a two stage method that offers high quality functional and cosmetic results. It does, however, usually involve ocular occlusion during the healing stage. This means for several weeks sight may be blocked in the eye. Some of the other procedures that can be used for medium to large areas include lateral canthotomy and cantholysis or a semicircular rotational flap.
Special Considerations for Upper and Lower Lids
When the lower lids require reconstruction it is recommended to repair this area in layers. Sometimes reconstruction of the lower lid may be done using what is called a Tenzel flap. This is a skin graft that is taken from the cheek area. Upper eyelids are in general considered to be a more detailed procedure. There are several important aspects of the upper lid that require attention to meticulous detail. A few of these include the ability to blink and corneal protection.
Recovery generally takes less than a week, with sutures removed during this time. Luckily, these procedures are not very uncomfortable, and over-the-counter Tylenol is all that is needed to control any discomfort. Keeping the head elevated when sleeping and staying hydrated can help reduce swelling during the healing process. Sometimes secondary procedures will be recommended to correct problems with the position of the lids or difficulties with the tear ducts. Another surgery may also be needed to remove excessive scarring.
Reconstructive surgery after Mohs tends to be very detailed as well as specific to the needs of each individual. When dealing with skin cancer on the eyelid, it is important to find a qualified oculo-plastic surgeon with both cosmetic and reconstructive experience specifically on the eyelids.