I often see patients with a type of skin cancer called basal cell carcinoma (sometimes called a “rodent ulcer”). These usually appear on the face, especially around the eyelids, nose or forehead.
What is a Basal Cell Carcinoma (BCC)?
A basal cell carcinoma (BCC) is the most common type of skin cancer. It usually grows slowly and does not spread to the rest of the body. But if left untreated, it can keep getting bigger and cause damage to nearby skin, especially around the delicate eyelid area, or spread backwards into the eye socket.
Many of my patients first notice a small lump, scab, or sore that just doesn’t heal. Sometimes it bleeds, crusts over, then comes back again. Gradually eyelashes are lost.
What are the causes of a BCC?
The main cause is sun damage. Sun cream can be difficult to apply around the eyes so sunglasses are essential.
Why surgery is the best treatment
Mr Lin sees BCCs very often so usually a biopsy is not required if the lump is likely to be a BCC, as a biopsy can delay full removal. Rarely a biopsy is necessary to confirm the diagnosis or to allow more detailed planning of removal. You will always have the option of a biopsy first.
What is the treatment for BCC?
Creams, cryotherapy, and radiotherapy can be used for certain types of BCCs. The most reliable way to remove a BCC is surgery which allows the tissue to be checked under a microscope to see if the BCC has been fully removed. Depending on the type of BCC and the location, the cancer can be removed and the defect closed at the same sitting, or the defect may be closed a week or two later after confirmation from the lab that the BCC is fully removed.
What are the aims of surgery?
The surgery is usually done under local anaesthetic (you’re awake, but the area is completely numb). The main aim of surgery is to completely remove the BCC. A small margin of normal-looking skin is also cut out to ensure that any tiny extensions of the BCC are also removed. The next aim is to repair the eyelid to allow it to work as normally as possible to protect the eye and restore a normal appearance as possible. I use specialist eyelid surgery techniques to repair the area. It may be necessary to borrow skin from elsewhere on the face or body i.e. a ‘skin flap’ or ‘skin graft’.
What happens after the operation?
Most people can get back to normal life within a few days.
After the surgery
- You can go home the same day
- Written instructions will be provided for you
- Before you leave you may be given lubricating drops for the eyes and antibiotic ointment for the wounds to use for a few weeks after the surgery.
- You should not drive yourself home.
When you get home after surgery
- If you feels sore when the anaesthetic wears off, take paracetamol.
- Avoid aspirin as this will encourage bleeding.
- Normally, the discomfort will settle within a few days.
- Ice packs (such as frozen peas wrapped in a clean towel) will reduce pain and swelling, and sleeping with more pillows to keep the head elevated will help.
Within the first few weeks after surgery
- You may start driving and working again as soon as the dressing is removed, as long as your vision is clear and you are not light-sensitive
- Clean the wounds gently with cooled, boiled water. Most forms of light exercise and a normal work pattern may be resumed within a few days
- Avoid heavy lifting, running or strenuous work-outs as you may worsen any bruising or swelling.
- Keep the skin dry until all scabs have fallen off.
- Eyelid makeup can be worn once any scabs fall off.
- I remove the stitches after 1-2 weeks.
- Depending on the location of the BCC, you cannot wear contact lenses for at least two weeks after surgery, as the eyelids may be stiff/sore, and your eye surface may be dry.
If you have severe pain, not relieved by simple painkillers, please contact Mr Lin on his mobile as provided.
⚠️ Risks to Consider
All surgery carries some risks, but I perform many hundreds of eyelid operations a year and take every step to keep them to a minimum.
Common and temporary:
- Bruising and swelling is normal (can take months to settle depending on the amount of surgerys)
- Dry eyes can worsen until the blinking muscles recover
- Mild blurred vision for a few days
Less common:
- Temporary numbness in the eyelid skin
- Small areas of skin looseness or asymmetry (can be corrected later). No surgeon is able to promise symmetry as healing is individual.
Rare:
- Obvious scarring, worse if an infection occurs. You may improve the appearance of any scarring by massaging the area with ointment e.g. Vaseline or silicon gel.
- Infection (higher risk in smokers/diabetics). The skin would become tender, red and more swollen and the wound may open and discharge. If this happens then you should contact the hospital as antibiotic tablets may be needed to help correct this and allow the lids to heal.
- Bleeding after the operation is usually slight and stops within a short time. If bleeding continues you should contact the hospital in case further treatment is required.
- The wound may open or the graft may come away or not survive
- Poor cosmetic outcome including asymmetry
- Damage to nearby structures such as the tear ducts
Long-term Care
As with any cancer, there is a small risk of the cancer returning or new ones growing, so it is important you self-monitor. If you see or feel any new lumps growing around the eyelids especially near the site of previous surgery it is important you see medical attention, either from the hospital or your GP/optician if you have been discharged. Signs of cancer include lumps with a centre that doesn’t heal, loss of eyelashes or double vision.
Sun protection such as sunglasses and sunblock are key to prevention. Vitamin B3 also know as nicotinamide has been shown to reduce the risk of skin cancers. This is available in oral or gel form.
Ready to Find Out if What You Have is Skin Cancer?
You can book a private consultation with me directly or see my team through the NHS with a referral.
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