What Should I Expect After Surgery
After surgery you may experience some pain. Simple paracetamol is usually enough to control this. The eyelids may be bruised and swollen, which may take up to 2 weeks to settle.
After Excision awaiting reconstruction 1 week laterPad to remain in place until returning for reconstructive surgeryIf the pad becomes loose, chloramphenicol should be applied to the wound and eye four times a day.
Not Melanoma But Serious Just The Same
As noted above, skin cancers on the eyelids are usually basil cell carcinomas or squamous cell carcinomas. Both of these types of cancer enlarge locally and usually do not spread to distant parts of the body. However, they still merit serious attention because if they are not removed they can invade adjacent structures. Both types of skin cancer are relatively slow growing, so early detection dramatically increases the successful removal of the tumor without having to take more adjacent tissue than is absolutely necessary.
Patient 1 Before And Seven Months After Lower Blepharoplasty Surgery
These photos show a woman in her mid-40s before and after lower blepharoplasty surgery. Prior to surgery, she has large under eye bags which make her look tired even when she is fully rested. Removing the under eye bags helps her look awake and refreshed. Notice how she still looks natural and doesnt look like she has had surgery.
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Patient 3 Before And Six Weeks After Lower Blepharoplasty Surgery
These photos show a patient in her early 30s before and after lower blepharoplasty surgery. Notice how she looks almost exactly the same after surery, just without under eye bags. Puffiness under the eyes is not always related to aging and can often be seen in the 20s and 30s. Surgery can be truly life changing for these patients, as they are often reminded of their issue multiple times a day when people ask them if they are tired.
Clinical And Pathophysiological Features
SCC typically manifests as a spectrum of progressively advancing malignancies, ranging from a precursor actinic keratosis to squamous cell carcinoma in situ , invasive SCC, and finally metastatic SCC. It is classified as in situ when it is superficial to the basal membrane, and it is considered invasive when it extends deep to the basal membrane layer of the skin. It is also possible to find in the literature others types of skin lesions classified as SCC variants, such as keratoacanthoma and cutaneous horn.
A full thickness biopsy is the gold standard to diagnose SCC as it can determine the depth of invasion and extent of invasion of the cancer. Patients with regional lymph node alterations should undergo Fine Needle Aspiration biopsy to determine if cancer cells have spread to these nodes. Invasive SCC is commonly associated with perineural spread.
In situ carcinoma
In situ carcinoma is the term for epithelial lesions in which cells have cytological abnormalities characteristic of malignancy and have lost their typical architecture but lack evidence of local invasion or distant metastases. In the skin, the squamous cell carcinoma in situ is known as Bowen’s disease. It appears as a persistent brown/red spot which may be confused with psoriasis or eczema. There is a strong association of Bowen’s disease with HPV infection, mainly type 16.
Squamous cell carcinoma
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Skin Cancer Patient 1
This patient was referred to Dr. Bhama by a Mohs surgeon for reconstruction of a nasal defect following Mohs surgery for basal cell carcinoma. On pre-op view notice the defect of the nasal tip. Options were discussed with the patient and she elected for paramedian forehead flap reconstruction. Surgery went well, and shown is an early post-operative photo. The scar will continue to improve with time. She was very happy with the cosmetic result and has no difficulty breathing through her nose.
What Are The Main Types Of Skin Cancer Seen In The Eyelid
Nearly 90% of skin cancers on the face are a single type called Basal Cell Carcinoma. It, like most skin cancers, forms as a result of cumulative sun damage over many years. The good news about Basal Cell is that it is a slow-growing skin cancer. It does not spread to other parts of the body and typically remains small in size. If it is left untreated, however, over many years, it can grow to a size that can affect your vision or the health of your eye.
The remaining 5-10% of skin cancers are made up of Squamous Cell Carcinoma, Sebaceous Gland Carcinoma, and Melanoma. These skin cancers are more aggressive than Basal Cell, and have a tendency to grow more quickly. They can often be associated with pain and discharge and redness of the eye. Melanoma can also spread to other parts of the body and represents a much more dangerous skin cancer that needs to be treated aggressively.
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Having An Eye Removed
Although rare, sometimes it is medically necessary to remove the eye. Because of this visual loss, a person with one eye may have trouble with depth perception. Most people adjust to these differences, with support from the health care team.
Many people worry about what they will look like when they have an eye removed. The cosmetic surgery available today usually yields good cosmetic results. To fill the area left by the missing eye, the person is fitted for a prosthesis . The prosthesis will look and behave almost the same as a natural eye. For example, the artificial eye will move along with the persons remaining eye, just not as much as a natural eye moves. Family members may be able to tell that the eye is not real, but it is unlikely that strangers will know.
If enucleation is required, talk with your doctor about a prosthesis. It may take many weeks for you to receive the prosthesis. Also, ask about support services that may be available to you to help adjust to the loss of an eye. Learn more about rehabilitation.
What Should I Do About My Medication
Mr McCormick will want to know all the medication that you take and about any allergies you have. In some cases you may be asked to stop or reduce the dose of blood thinning tablets like: warfarin, apixaban, dabigatran, aspirin, clopidogrel , dipyridamole . This decision is made on an individual basis and you should only do so if it is safe and you have been instructed by your GP, surgeon or anaesthetist. This will be discussed with you before surgery. Other medication should be taken as usual. You should avoid herbal remedies for 2 weeks prior to surgery as some of these may cause increased bleeding at the time of surgery.
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D Six Months After Surgery
This patient had a pigmented area below her right eye which had been stable in size and appearance for more than 30 years. A biopsy was performed after the lesion starting increasing in size and showed lentigo maligna, a superficial form of malignant melanoma. The lesion was excised by Mohs surgery and reconstruction was performed using advancement flaps to bring adjacent skin into the defect. At six months, the eyelid is well healed with only minimal evidence of surgery. Careful examination shows that the right lower eyelid is in a slightly lower position than the eyelid on the left side.
Surgical Procedures For Basal & Squamous Cell Skin Cancers
Basal or squamous cell skin cancers may need to be removed with procedures such as electrodessication and curettage, surgical excision, or Mohs surgery, with possible reconstruction of the skin and surrounding tissue.
Squamous cell cancer can be aggressive, and our surgeons may need to remove more tissue. They may also recommend additional treatments for advanced squamous cell cancer, such as medications or radiation therapyenergy beams that penetrate the skin, killing cancer cells in the body.
Basal cell cancer is less likely to become aggressive, but if it does, our doctors may use surgery and other therapies to treat it.
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Principles Of Skin Cancer Management
There are three very important principles in the management of eyelid skin cancers:
- Complete removal and
- Reconstruction of the area to preserve vision
After these two are achieved, the final, important principle is for the fully trained eye and facial surgeon to design the surgery to give the optimal cosmetic result.
Eyelid Basal Cell Carcinoma Before And After Photos
Dr. Kapadia regularly treats patients with cancers involving the eyelids. Eyelid reconstruction is not cosmetic surgery and not everyone has a perfect result. Nonetheless, most patients are very pleased with their outcome and show minimal evidence of surgery after they heal. Approximately 10% of all skin cancers occur on the eyelids. As in other parts of the body, basal cell carcinoma is the most common type of eyelid skin cancer.
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Skin Cancer Patient 7
This patient underwent Mohs surgery for excision of a basal cell carcinoma from the nose and was referred to Dr. Bhama for repair of the resulting defect. Note the defect of the left nasal ala. Because of the importance of this structure in breathing, the patient had to undergo not only reconstruction of the skin defect, but repair of the nasal valve to facilitate breathing. She underwent complex staged reconstruction using an interpolated melolabial flap with auricular cartilage grafting. Her intermediate photo is also shown, demonstrating the pedicled flap. Also shown in an early post-operative view demonstrating excellent contour of the nose. No revision surgery has been performed, and no steroid injections have been performed.
What Is Mohs Excision Surgery
Mohs surgery is carried out by a dermatologist who has been specially trained in this technique. This is usually at a clinic in another hospital. The skin cancer is removed in thin slices. Each slice is looked at immediately by the Mohs surgeon. The Mohs surgeon keeps excising until he is certain all of the tumour is removed. This is most suitable for squamous cell carcinoma and basal cell carcinoma, particularly when the margin of the tumour is difficult to see with the naked eye or when tumour is recurrent after previous reconstruction. The reconstruction takes place usually within 2 days
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Before And After Photo Gallery
- Patient Seeing Straight
This patient had a large, nodular basal cell carcinoma of her right lower lid. It was excised completely and there was an approximate 25-30% defect in the lower lid. The black mark denotes the amount of eyelid that was resected in order to remove the skin cancer.
She underwent eyelid reconstruction in the operating room using local advancement of tissue. She did well and this photo was taken 6 weeks after surgery. Note the lid symmetry and lack of abnormal scar formation.
- Patient Seeing Straight
- Patient Seeing Straight
This patient was seen by her Dermatologist specialized in Mohs surgery and underwent a removal of a large basal cell carcinoma that involved her eyelid, medial canthus, and lower cheek.
She underwent reconstruction of her eyelid, medial canthal, and lower cheek in the operating room using local advancement flaps. She is four months out in this photograph above and shows a great result with little scarring. Some patients tend to scar more than others and we attempt to optimize our patients as best as possible before, during and after surgery to help prevent as much scarring as possible. The surgery was done in conjunction with Dr. Richard Zoumalan, a facial plastic surgeon who works alongside Dr. Christopher Zoumalan on complicated eyelid and facial plastic procedures to produce the best desired outcome.
- Patient Seeing Straight
Lower Blepharoplasty Before And After Photos
This page shows before and after photos of actual patients who have had lower blepharoplasty surgery with Dr. Kapadia. Lower eyelid surgery is used to treat puffiness under the eyes, commonly referred to as under eye bags and entails carefully removing excess fat from the lower eyelids. In some patients, excess skin is also removed or tightened with a laser.
Under eye bags often cause people to have a tired, aged appearance, even when they are fully rested. Reducing the appearance of the under eye bags leads to a refreshed, less tired look as seen in the photos below. As always, the hallmark of Dr. Kapadias style is to produce natural looking results. Notice how no one looks pulled tight or surgical after surgery.
The eyes are usually the first thing notice when they look at a face and are often one of the first parts of the face to show signs of facial aging. Eyelid surgery alone can often make a dramatic improvement in overall appearance of a face, as seen in the examples below.
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What Is A Skin Flap
A skin flap is similar to a skin graft except that the donor skin is not completely detached. This means that it retains some of its own blood supply which usually produces superior results. A skin flap donor site is usually immediately adjacent to the defect, allowing the skin flap to be mobilised and rotated or slid into place in the defect.
Skin Cancer Patient 4
This patient was referred to Dr. Bhama for a mass on the right lower eyelid. Dr. Bhama performed biopsy which confirmed skin cancer . On initial photos, noticed the ulcerated mass of the right lower eyelid margin. Dr. Bhama referred the patient for Mohs surgery. Mohs surgery was performed and the patient returned to Dr. Bhama for reconstruction. On pre-reconstruction photos noticed the massive full-thickness defect of the lower eyelid. Most of the oral eyelid has been removed. The underlying muscle has also been removed as has the tarsal plate and conjunctiva. Options were discussed with the patient. Dr. Bhama performed tarsal conjunctival flap advancement with contralateral upper eyelid skin graft . Intermediate stage photos are shown and early postoperative reconstructive photos are shown. The patient has an excellent eyelid contour that will continue to improve with time. The swelling of the eyelid margin will continue to settle down. He has complete eye closure and was very happy with results. Notice the crescent shaped contour of the lower eyelid, appropriate amount of scleral show, and symmetry of the palpebral aperture.
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Skin Cancer Patient 6
This patient was referred by a Mohs surgeon to Dr. Bhama for management of an aggressive squamous cell carcinoma of the right brow and forehead that appeared to be adherent to the underlying deep tissues and possibly bone. Because the tumor was aggressive, surgery was performed in an expeditious manner. Pre-operatively, notice the large scab overlying the brow. There was a extension of the tumor deep to the skin in all directions for several centimeters, and the tumor invaded the muscles of the forehead. Dr. Bhama excised the tumor under local anesthetic in our Mill Creek procedure room. The tumor invaded the frontalis muscle which had to be removed. After removal of the tumor, there was a large defect of the forehead and brow, extending into the upper eyelid. Dr. Bhama performed reconstruction under general anesthesia using an A to T flap technique, recruiting tissue from both the forehead and temple. A 1 month post-operative result is shown demonstrating excellent healing and a good cosmetic result considering the entire lateral brow had to be removed. No revision surgery, injections, or dermabrasion have been performed. The scar will continue to fade, and the notching will be repaired under local anesthetic.
Eyelid Before / After Photos
Aging of the lower eyelids is typically associated with the development of crepey, lax skin, volume loss around the bony orbital rim and upper cheek as well as bulging of fat pads around the eyes. Aging of the upper eyelids often presents as excess skin over the eyelids as well as a general volume loss in the areas beneath the brows and upper eyelids.
There are a few ways to perform upper and lower eyelid surgery, depending on your skin and goals. Upper eyelid surgery involves the removal of excess skin over the upper eyelids, which creates a more youthful eyelid show. Upper eyelid surgery scars are minimal and hidden in the natural eyelid crease. Lower eyelid surgery often uses the transconjunctival method, which puts the incisions on the inside of the eyelid.
Individual results will vary* and therefore a consultation with double board certified Dr. Sudeep Roy is the best way to know what to expect from your procedure. Schedule a consultation by calling 414-6179, or starting a chat from our website.
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Repair Droopiness And Remove Lower Eyelid Bags
This lovely lady who was in her 40s was unhappy with the bags in her lower eyelids and deep tear troughs. She was also unhappy with the droopiness of her left upper eyelid. She underwent bilateral lower blepharoplasty to remove her bags and tear troughs and left upper ptosis repair to achieve more symmetric upper eyelids and a brighter appearance.
C Three Months After Surgery
This patient had a small area of redness and scaling of the left upper eyelid which was barely visible in the preoperative photo. A biopsy of this area was positive for squamous cell carcinoma. The tumor was excised by Mohs surgery and reconstruction was performed with a skin flap to bring adjacent tissue into the defect. The eyelid is fully healed three months after surgery.
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Remission And The Chance Of Recurrence
A remission is when cancer cannot be detected in the body and there are no symptoms. This may also be called having no evidence of disease or NED.
A remission may be temporary or permanent. This uncertainty causes many people to worry that the cancer will come back. While many remissions are permanent, its important to talk with your doctor about the possibility of the cancer returning. Understanding your risk of recurrence and the treatment options may help you feel more prepared if the cancer does return. Learn more about coping with the fear of recurrence.
If the cancer does return after the original treatment, it is called recurrent cancer. It may come back in the same place , nearby , or in another place .
When this occurs, a cycle of testing will begin again to learn as much as possible about the recurrence. After testing is done, you and your doctor will talk about your treatment options. Often the treatment plan will include the treatments described above such as surgery, chemotherapy, and radiation therapy. However, they may be used in a different combination or given at a different pace. Your doctor may also suggest clinical trials that are studying new ways to treat this type of recurrent cancer.
Whichever treatment plan you choose, palliative care will be important for relieving symptoms and side effects.