LidLift's Blog

Mohs Surgery for Basal Cell Carcinoma of the Eyelid

Skin cancer is very common and for the most part is the result of chronic sun exposure.   The three most common forms of skin cancer include basal cell carcinoma, squamous cell carcinoma, and malignant melanoma.  By far the most common one is basal cell carcinoma.  This type of skin cancer is seldom fatal; however, it can cause extensive local destruction and if neglected, it can cause enough damage that leads to life threatening complications.  Fortunately, diagnosed early, it can be treated successfully with a variety of methods.  However, when it involves the eyelid, the challenge is to completely excise the cancer, yet preserve as much of the eyelid structure and function as possible. Mohs’ cancer surgery for basal cell carcinoma of the eyelid, has become the preferred method for accomplishing this task.  This specialized surgical technique, developed by general surgeon Frederic Mohs at the University of Wisconsin, has a very high cure rate for skin cancers like basal cell carcinoma and others.  This surgery focuses on the microscopic examination of the excised tissue, and it has radically changed how eyelid cancers are managed.

Basal Cell Carcinoma Skin Cancer

Basal cell carcinoma is the skin cancer that most commonly affects the eyelids, and the lower eyelid is most commonly affected.  Skin cancer has the potential to disfigure the eyelids, and often does.  When the eyelid is affected by skin cancer, the primary goal is of course to remove the immediate threat of the cancer before it spreads or worsens.  Early intervention improves your chances of being cured, and in all cases surgical excision is key to eliminating or at least controlling the cancer.  Of the different types of skin cancers that affect the eyes, basal cell carcinoma is unlikely to spread or metastasize to a distant site, but it does damage local tissue without treatment.

The Importance of Definitive Treatment

The best eyelid skin cancer treatment involves an expert team of physicians.  The traditional method is to have an eye plastic or general plastic surgeon remove the cancers, then have a pathologist examine the edges of the removed tissue through frozen sections.  This method has a high success rate, but there is another team approach with even better eyelid cancer prognosis.  In this method, a dermatologist surgeon who specializes in Mohs cancer treatment excises the tumor or cancer and an oculoplastic surgeon like Dr. Steinsapir reconstructs the eyelid.  This team physician approach enables you to receive the best, most specialized treatment for each component of your surgery.  We typically see at least the following three benefits with this process:

  1. Although both have very good outlooks, the Mohs surgery success rate is much higher than frozen section control.
  2. Mohs surgery reconstruction preserves more of healthy surrounding tissue.  Since the eyelids and tearducts are crucial to the function of our eyes, and because their arrangement is a key part of our aesthetic appearance, conserving as much tissue as possible improves both functionality and aesthetics.
  3. Mohs surgery recovery time is faster because the least amount of normal tissue is removed when the skin cancer is excised.

Reconstructive Surgery after Cancer

Reconstructive eyelid surgery benefits many people who may not initially be aware that their results can be improved.  Often the closure performed at the time of surgery may be the best compromise at the time, the operating physician does not specialize in eyelid reconstruction, or the reconstruction needs to occur in multiple stages.  Benefiting from additional reconstructive surgeries after your cancer is initially removed in no way reflects poorly on the first surgeon.  Given the nature of cancer, the first concern is always to eliminate it, and this often presents obstacles to your functional and aesthetic needs.  Your doctor made decisions based on the dangers you faced and likely chose the best option.  If only one surgeon performed your procedure, you may have had a great specialist in skin cancer removal who did not specialize in eyelid reconstruction.  If your cancer is gone, your first surgeon clearly did a commendable job.

However, this does not mean that you can’t seek a new opinion on whether you’ll benefit from further eyelid reconstruction.  Some may fear that they’ll appear vain or ungrateful if they’re dissatisfied with the face cancer has left them.  This is not the case.  You have survived cancer, and it is fair and understandable that you want to feel, look, and function at your best.  It’s important to understand the healing stages of cancer surgery when considering reconstructive options; while we don’t want to downplay the benefits of a great initial closure, we also recognize that different options open up at each stage during and after healing.  In time, the body repairs the microcirculation in the operated area, enabling deficiencies to be reassessed and corrected or improved with revisional surgery.

Make Us a Part of Your Healing Experience

Often a fresh perspective can vastly improve a situation that previously seemed to have very few options.  Dr. Steinsapir, a Los Angeles oculoplastic surgeon, customizes eyelid reconstruction on an individual basis by combining scientifically proven methods with his artistic vision and extensive experience.  He frequently collaborates with other specialized physicians to deliver the best Mohs treatment possible.  Many also find that after surgery, a second opinion from Dr. Steinsapir is very helpful.  Dr. Steinsapir’s attitude is both positive and realistic; he commends the skill and importance of doctors who do wonderful work in treating skin cancer, and to this he brings his personal specialization in eyelid reconstruction.  A team approach is often the best way to meet all your needs in a complex medical situation.  We invite you to a personal consultation with Dr. Steinsapir to find out how he can be a vital member of your treatment team.  Contact us today to find out how Mohs surgery or reconstruction can be a part of your treatment plan.