Skin Cancer Reconstruction

Lesion Excision and Cancer Reconstruction

Eyelid skin cancer and trauma are two of the most common reasons a person may need eyelid reconstruction. As an oculoplastic surgeon with experience in both ophthalmology and plastic surgery, Dr. Angelo Tsirbas is an expert in eyelid reconstruction. Even if the entire upper and lower eyelids were damaged from trauma or tumor, Dr. Tsirbas can reconstruct the eyelids by harvesting tissue from other parts of the body. This task is always accomplished by keeping these important goals in mind: preserve vision, prevent blindness, maintain eyelid function and improve cosmesis.

Lesions on or around the eyes are fairly common in the Australian population.  Many contributing factors including sun-damaged skin can lead to cancerous lesions on or near the eyes.  Dr. Angelo Tsirbas’ specializes in both the removal and the reconstruction of such lesions.  Furthermore, he works very closely with accredited MOHS surgeons in Sydney who remove skin cancer tumours using a specialised technique.

Eyelid cancers:

Basal cell carcinoma: More then 90% of all malignant eyelid tumors are basal cell carcinoma. It usually presents as a small, firm and raised nodule with an ulcerated center and fine telangiectatic blood vessels. Although these tumors do not metastasize to lymph nodes or distant organs, they can cause extensive local destruction.

Squamous cell carcinoma: Although less common than basal cell carcinoma, squamous cell carcinoma is much more aggressive. Most of the time it is locally invasive, but it can metastasize to regional lymph nodes and even produce systemic metastatic cancer. Wide surgical excision of these tumors is the primary treatment. Sometimes when there is extensive involvement or adequate margins are not obtained, radiation therapy or other treatment modalities may be used.

Malignant melanoma: Melanoma is a relatively rare cancer of the eyelid and accounts for less then 1% of all eyelid malignancies. The tumor thickness should first be identified via a biopsy to determine the required margin of resection. The thicker the tumor (on biopsy), the higher the likelihood of local recurrence and distant metastasis. Complete surgical excision of these tumors with 5-10 mm clear margins is recommended. At the time of diagnosis, a systemic evaluation should be undertaken to assess distant metastasis. These patients need to be followed closely.

Sebaceous cell carcinoma: This is a rare type of cancer involving the eyelids. These tumors primarily originate from the meibomian glands, sebaceous glands of the eyelids that normally produce the oily layer of the tear film. These tumors can be mistaken for some more benign conditions, such as a chalazion or “sty.” Any “sty” that does not heal and resolve with medical treatment or surgical drainage should be biopsied to rule out sebaceous cell carcinoma. The treatment consists of surgical excision and long-term monitoring for regional lymph node or distant metastasis.

The Procedure:

Dr. Angelo Tsirbas could use one of many procedures in order to remove the tumour and reconstruct the eyelid.  This will be decided on an individual basis in your consultation with him. Some of the factors affecting the procedure used will be the size and type of the defect, your age, biologic behaviour of the tumour, age of the wound, and any previous treatment.  One procedure to remove the skin cancer may be the MOHS technique.  Dr. Angelo Tsirbas works closely with highly qualified MOHS surgeons and has extensive experience in repairing facial defects created by MOHS surgery.  Several different types of flaps or grafts maybe used for repair. The advantage of using the MOHS technique over standard excision is that the edges of the removed cancer are carefully examined under the microscope that allows the MOHS surgeon to be certain that the entire cancer has been removed without taking any healthy tissue away and without leaving any of the “roots” behind.

Length of time in theatre:

Dependant upon the technique chosen by you and Dr. Angelo Tsirbas; the procedure can take between 30 minutes and 2 hours.

Recovery time:

Most patients go home immediately after the procedure; you will be observed for approximately one hour after the surgery before being discharged with a companion. Most patients can go back to work the day after the procedure. Some people opt to take more time off depending on the type of repair performed.

Anaesthesia:

Most reconstructions are performed under local anaesthesia. Rarely is general anaesthesia required.

Results:

Removal of the defect and reconstruction of the eyelid to return it to its normal position.