More Than Meets the Eye

By Soheila Rostami, MD

It is quite common for patients to be referred from other physicians that have been diagnosed with a cancerous cell on or around the eyelids. These cancerous cells are known as basal cell or squamous cell carcinomas. The majority of patients never even knew these lesions existed until their physician made them aware during their examination.

For the average patient, most lesions appear after age 40. At that age, loss of the ability to be able to see things close-up begins to set-in, and we begin having a hard time looking at small things without the use of reading glasses. Because of this it is difficult for us to notice any type of eyelid lesion, since most lesions are very small and inconspicuous.

Since most skin cancers do not cause irritation or have noticeable symptoms (until the advanced stages), there are very few factors that can alert us to the need for seeking medical help for those lesions.

Eyelids play a key role in keeping and protecting our sight. The average eyelid is only 30mm in length, so it is easy to see that a small piece of removed eyelid can be very damaging both now and in the future. Any damage to the eyelids can put our vision in serious danger. The detecting and removal of cancerous lesions of the eyelids, therefore, is very important.

The sooner that the lesion is detected and removed, the lesser amount of the eyelid usually has to be removed. It is also easier to repair the defect of the eyelid when the lesion is detected in the earliest stages. There are many different techniques to repair eyelid defects, but the simplest and best results come from the direct closure of the defect, which is only possible if less than one-third of the eyelid is missing or damaged.

Many eyelid lesions do not look like typical skin cancer and can be mistaken for benign lesions. Therefore, the recommendation from the American Academy of Ophthalmology is that all eyelid lesions be biopsied or removed. It is also recommended that the lesions be sent for analysis. Although this is the recommendation, we would encourage patients to urge their physician to send any excised eyelid lesion in for biopsy/pathology. Better to be safe than sorry.