Periocular (eye) skin cancer treatment is offered by consultant ophthalmic and oculoplastic surgeon, Mrs Sabrina Shah-Desai, in Brentwood, Essex at Spire Hartswood Hospital.
There are three main types of cancer found in the eye area:
What is basal cell carcinoma?
The most common type of skin cancer seen in the periocular (eye) area is basal cell carcinoma (BCC). This cancer arises from the basal cells and is also called a “rodent ulcer” as it grows very slowly.
What is squamous cell carcinoma?
Another common skin cancer in the periocular area is squamous cell carcinoma (SCC). This is a more serious form of cancer than BCC, as it can spread to other parts of the body.
A squamous cell carcinoma may appear as a painless nodule, or a sore, that won’t heal. The skin may be ulcerated, or there may be bleeding, crusting or distortion of the normal eyelid structure and loss of eyelashes.
What are melanomas and sebaceous gland carcinomas?
Another condition is melanoma, which can arise from pigment producing melanocytes, and is a less common but more serious form of skin cancer. A mole that bleeds, becomes tender, changes size, shape or colour needs to be seen urgently by a physician.
Sebaceous gland carcinoma is a more serious but rarer form of skin cancer. It may appear as a recurrent chalazion (a cyst in the eyelid caused by inflammation of a blocked meibomian gland, often mistaken for a stye), persistent eyelid inflammation, chronic red eye or thickening of the eyelid.
Melanoma and sebaceous gland carcinomas can spread (metastasize) to other parts of the body through the blood stream or lymphatic system. Prompt, aggressive treatment is necessary because of risk of early spread.
Removal of periocular cancers at Spire Hartswood Hospital
Early and complete removal of periocular skin cancers are vital to reduce the chance of a recurrence, and to reduce the spread to other parts of the body.
Complete surgical removal is the most effective treatment and is necessary to reduce the chance of recurrence. The resultant excision requires reconstruction to preserve eyelid function, to protect the eye and to provide a satisfactory cosmetic appearance.
Excision of the skin cancer can be done by ‘Mohs’ (micrographic) surgery, which is performed by a specially trained dermatologist. The skin cancer is removed layer by layer under microscopic control, and the ophthalmic plastic surgeon repairs the area once the cancer is removed. Alternatively your surgeon may elect to remove the skin cancer with a small margin of normal tissue. This is then sent for examination by a pathologist to determine if the entire tumour has been removed, which can take 24 - 48 hrs or as long as 2 weeks.
Further reconstructive surgery is dependent upon the size of the excision. Small areas can be repaired by stitching the edges together, and larger areas may require local flaps or free skin grafts to close them. Again, depending upon the size of the excision, surgery can range from a simple 30-minute procedure to a more complicated 2-hour procedure.
Radiation therapy and cryotherapy (freezing with liquid nitrogen) may be useful in treating certain types of cancers particularly in patients who cannot tolerate surgery, or in addition to surgery in more aggressive type of skin cancers.
Certain types of superficial lesions and precancerous lesions can be treated with immune modulating topical drugs, such as “Aldara”, by a dermalologist.
The risks and complications of periocular surgery
Minor bruising or swelling, which settles in 1-3 weeks can be expected. Bleeding and infection, which are potential risks following any surgery, are very uncommon. Occasionally the eyelid may look a bit different, perhaps smaller or larger than before. If the skin cancer involves the tear drainage system, the eye may need further surgery.
Recurrence is rare but may occur even after complete excision of a skin cancer and it is much more common if the lesion is not completely excised.