Skin cancer of the eyelids is more common than most think. It is especially frequent in lower Delaware due to our sunny outdoor lifestyle - both at work and play.

While there are four principal types of eyelid skin cancer, basal cell is by far the most common, and fortunately the least dangerous. If removed in its entirety, cure is ensured. This type of skin cancer does not migrate to other organ systems.

These tumors arise from the “basal” or lowest level of the skin’s top layer. This top layer of the skin, called the epidermis, is the most exposed to the high energy damage caused by ultraviolet light. As the atmospheric ozone layer becomes more depleted, these UV rays are able to increasingly reach and damage our epidermis. In susceptible individuals, especially those with fair skin, uncontrolled cell division occurs and a basal cell tumor grows without limit.

These tumors are usually present for months before the patient is aware of it. Typically they present as a raised nodular lump in the skin with a pearly color and are often accompanied by a fine blush of blood vessels over the top of the lesion. Most commonly they are found in the lower eyelid which catches the sun’s rays most directly.

When found, they should be biopsied for accurate identification as benign or malignant, and if malignant, what type (basal, squamous, sebaceous, melanoma). If caught early enough, a simple excision in the office will suffice for cure. When the lesions are more extensive, larger than a pencil eraser, an oculoplastic surgeon is best able to determine the proper course of action to remove the lesion, reconstruct the eyelid, and achieve the best possible functional and cosmetic result.

A well trained and experienced oculoplastic surgeon has the ability to reconstruct an entire eyelid from the patient’s own adjacent tissues to deliver the aforementioned objectives of cure, reconstruction, and cosmetics. Generally the surgery is performed in an outpatient setting lasting about one hour and requires a pathologist to examine the tumor specimen to be sure it has been removed in its entirety to prevent recurrence. Done in this way, recurrences are less than one percent. A patch may be worn for up to five days, and occasionally a second (planned) surgery is necessary to complete the eyelid reconstruction.

Patients can expect to be cured, have a comfortable, seeing eye, and a good cosmetic result. •

Dr. David Larned is a Board Certified Ophthalmologist who is fellowship trained in Ophthalmic Plastic and Reconstructive Surgery at the Wills Eye Hospital in Philadelphia. He specializes in oculoplastic surgery, orbital and facial trauma, Botox, abnormalities, and skin cancer of the face and eyelids. For more information about the above procedures or to schedule an appointment with Dr. Larned, please call 302-684-2020.

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