What is are eyelid skin cancers?
There are many types of skin cancers than can affect the thin delicate skin around the eyes. By far the most common are basal cell carcinomas, followed by squamous cell carcinomas. More rarely are melanomas and sebaceous gland carcinomas. The latter two are aggressive and are more likely to spread around body. Mr Lin has written papers on this skin cancers around the eyes here and here.
Pre-cancerous changes can also occur. Cells can be on a spectrum between non-cancerous and cancerous, and can sometimes grow without invading deep into the skin. This includes conditions such as Bowen’s disease and keratoacanthoma. Usually, it is sensible to biopsy or excise these fully for confirmation of diagnosis and also to prevent change into a full blown cancer.
What are the causes of eyelid skin cancers?
- Sun exposure
- Fair skin
- Genetics
- Immunosuppression
Will a biopsy be taken?
Mr Lin regularly sees eyelid skin cancers so a biopsy is often not required if the diagnosis if obvious. A biopsy can delay full removal, however 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. Clinical diagnosis and even histological diagnosis (looking an individual cells under a high-powered microscope) are not 100% accurate.
What is the treatment for skin cancers?
Various treatments including creams, cryotherapy, tablets and radiotherapy can be used depending on the type of cancer. The most common treatment is surgery which allows the tissue to be checked under a microscope to see if the cancer has been fully removed. Depending on the type of cancer and the location, the cancer can be removed and the defect closed at the same sitting, or the defect may be closed a week later after confirmation from the lab that the BCC is fully removed.
What are the aims of surgery?
The first aim of surgery is to completely remove the cancer. A margin of normal-looking skin is also cut out to ensure that any microscopic extensions of the cancer are also removed. The next aim is to repair the eyelid to allow it to function as normally as possible to protect the eye. Mr Lin will reconstruct the tissue so that it looks as normal as possible. It may be necessary to borrow skin from elsewhere on the face or body i.e. a ‘skin flap’ or ‘skin graft’.
For more aggressive cancers such as melanoma or sebaceous gland carcinoma, further body scanning and biopsies from the rest of the body may be required to check for spread.
What happens after the operation?
Written instructions will be provided for you. The key aftercare aspects are to minimise infection, bleeding/bruising, swelling and discomfort. Before you leave you will 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. Clean the wounds gently with cooled, boiled water. If your eye 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.
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. Most forms of light exercise and a normal work pattern may be resumed within a few days of surgery. Avoid heavy lifting, running or strenuous work-outs for four weeks 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. Mr Lin will remove the stitches after 1 week. Depending on the location of the cancer, 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.
What problems can occur after the operation?
Mr Lin performs many hundreds of eyelid operations per year and will draw on his expertise to minimise the risk of problems.
- Bruising and swelling of the eyelids is normal. The surface of the eye may also swell. These changes will settle after a few weeks, and will take longer to resolve in patients with blood thinners.
- Dry, gritty, sensitive eyes for a few weeks can be helped with lubricant eye drops. The vision may be slightly blurred for a few days. A dry eye problem may be worsened by the surgery, and more frequent lubricating eye drops may be required
- 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.
- A post-operative infection may rarely develop in the lids when they 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.
- The wound may open or the graft may come away or not survive
- Incomplete eyelid closure. The eye may not close fully especially at night. There is a risk of the front surface of the eye becoming dry and uncomfortable. Drops and ointment may correct this. Traction on the lid may cure a mild amount of overcorrection, but occasionally further surgery is required
- Asymmetry or poor contour or eyelid scarring. You may improve the appearance of any scarring by massaging the area with ointment e.g. Vaseline or silicon gel
- Extremely rarely, severe bleeding can spread behind the eye that can cause loss of vision. This is why aspirin and physical exertion are discouraged for the few weeks after the operation.
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.