Eyelid tumours (Eye Lid Cancer) are common in Queensland. Small lesions initially, they grow in size over time. Surgical excision is most often curative, so early diagnosis is imperative. Following excision, the eyelid needs to be reconstructed to restore function with a cosmetically acceptable result .
See Gallery of Eyelid Reconstruction surgery outcomes
After excision of the tumour, it is stained and microscopically examined and a determination made of whether the tumour has been completely removed.
There are three methods by which the tumour can be excised and margin clearance can be determined:
1. Mohs surgery: the excision is performed by a Mohs Micrographic surgeon, a specialist Dermatologist, and who also examines the specimen themselves and sequentially enlarges the excision margins until the tumour is cleared. A time consuming process that enhances tissue preservation, particularly useful for recurrent skin cancers and tumour excision of the medial canthus, eyelids, nose and ears. Afterwhich, the patient is transferred to the care of the Oculoplastic Surgeon for repair the medial canthal or eyelid defect. Dr Smith works with Dr Dougal Coates (MBBS, FACD) and Dr Karyn Lun (MBBS, FACD), who are two of only a handful of Mohs surgeons in Queensland.
2. Frozen section: the excision is performed by the Oculoplastic Surgeon, which is immediately examined by a waiting Dermatopathologist, a subspecialist in Pathology. The Dermatopathologist will report back within 30 minutes if the tumour is cleared, and if not, instruct where further tissue needs excising. This process was the Gold standard for many years, but results with Mohs are better for eyelid cancer.
3. Excision with delayed closure (“slow Mohs): the excision is performed by the Oculoplastic surgeon and it is then sent off to the laboratory for histological examination. A dressing is applied to the wound. Within 24 hrs, a report is issued, and the determination of whether further excision is required or the wound can be reconstructed. If a further excision is required, the process is repeated with the same one or two day turn around. Once the tumour is excised, the eyelid can be reconstructed. This method can be time consuming for the patient, as it requires multiple visits to the clinic on consecutive days, but is otherwise the most cost effective way of achieving the desired outcome for uninsured patients.
All three methods effectively achieve the same outcome of ensuring the skin cancer is removed. Costs vary according to the various options, and which option best suits you should be discussed with your surgeon. Both Medicare and most Private Health Funds provide rebates for this type of surgery. Surgery is usually performed under local anaesthetic, but options of monitored sedation or general anaesthetic are possible. Mohs Micrographic surgery can be arranged with a single consultation with Dr Smith.