MOHS Reconstruction

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Skin cancer is becoming more common as we develop better diagnostic techniques, as our population ages and as sun exposure increases.  Skin cancer often involves the skin of the eyelid or adjacent face.  Indeed, sun exposed areas of the body are more commonly affected by skin cancer.  They usually appear as painless lesions or nodules.  There may be loss of eyelashes, ulceration of the skin, bleeding and distortion of the normal structure of the eyelids.  When these findings are noted, they need to be evaluated and may require a biopsy to confirm the diagnosis.

The most common types of skin cancer are basal cell carcinoma and squamous cell carcinoma. In general, these are painless elevated nodules that enlarge locally and rarely spread (metastasize) to different parts of the body. If not treated promptly, these lesions can enlarge to involve adjacent structures including the eye. There are several ways to treat these lesions including cryotherapy (freezing), topical chemotherapeutic agents, and surgery. Complete excision (with the aid of frozen sections or Moh’s surgery) of the lesion has been shown to be the most effective method of treatment. Once the lesion is excised completely, the resultant defect can be reconstructed with various reconstructive techniques.

Sebaceous gland carcinoma and malignant melanoma are more rare than the above tumors and more serious forms of skin cancer. These tumors not uncommonly spread to adjacent and distant parts of the body. When these diagnoses are made, prompt aggressive treatment is required because of the threat of early spread.

Preoperative Evaluation

Preoperative Evaluation of patients with eyelid lesions is much the same as patients with eyelid deformities.  When a malignancy is suspected however, evaluation of regional lymph nodes and/or possible metastasis (spread to distant sites) may be performed.

As with the treatment of any other eyelid abnormality it is imperative that all patients have a thorough examination of their eye.  This starts with a measurement of the visual acuity.  A complete examination of the ocular surface, tear film and contents of the eye is performed.  Occasionally, eyelid cancer can occur in systemic illness which must be addressed.

The Surgery

Surgery for eyelid lesions is individualized to the patients particular deformity.  Frequently, patients are asked to arrive 1-2 hours prior to surgery.  This allows the nursing staff to draw appropriate lab work, start an IV and answer any further questions you may have.  An anesthesiologist will discuss anesthesia prior to surgery and answer any questions you may have.

It is not uncommon in the reconstruction of eyelid deformities to need to graft tissue from one part of the body into the eyelids.  Common donor sites include the oral mucosa, skin from behind the ear, skin from the eyelid, cartilage from the ear or nose and fascia (tough fibrous tissue) from the lateral thigh.

Postoperative Care

Postoperative care after excision of eyelid lesions is individualized to the patients specific abnormality.  It is not uncommon to be instructed to leave an eye patch on for 24 hours.  The wounds patient may be instructed to clean the wounds with sterile saline solution or hydrogen peroxide twice daily and antibiotic ointment placed on the wounds.  Many patients are treated with oral antibiotics for 5-7 days after surgery.  A follow up appointment with your physician will be scheduled within 5-7 days.

Complications

Eyelid surgery is very safe.  Bruising and swelling are common and usually subsides within 1-2 weeks.  Inability to close the eye is also common during the first 1-2 weeks.  Significant scarring and pain are unusual as is infection.  As with any surgery in and around the eye, there is a risk of loss of vision.  Most experts believe that this risk is approximately 1/40,000.  Any significant postoperative bleeding, pain, redness or visual disturbances must be reported to your physician.

Most eyelid surgery is performed in the office or as an outpatient under local anesthesia.  Complications are very rare and include:  bleeding, infection, bruising, swelling, inability to close the eye, scarring and loss of vision.  Because we have a unique understanding of the eye and plastic surgery, we are frequently asked to correct eyelid deformities in other surgeon’s patients with sub optimal results.

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