Reconstruction after Skin Cancer Removal (Mohs Reconstruction) Miami

Skin cancer is the most common form of cancer. According to the American Cancer Society, almost 5.5 million skin cancers are diagnosed in the United States every year, and that number appears to be steadily rising. It is estimated that 93% to 97% of all skin cancer occurs on highly visible parts of the body such as the head, face, ears, neck, hands, and arms. It is easy to understand why this is the case, considering the fact that these parts of the body typically receive the most sun exposure. About 1 in 5 Americans will develop skin cancer in the course of a lifetime.

The areas around the eyes, on the eyelids, or near the brows are surprisingly common places for people to develop skin cancers (See Figure 2 below). According to the Skin Cancer Foundation, “skin cancers of the eyelids…account for 5–10% of all skin cancers [on the entire body].” Of the skin cancers that are diagnosed on the eyelids, 95% of these tumors are basal cell carcinomas or squamous cell carcinomas.”

The good news about skin cancer in general, is that early detection of most forms (while the cancer is still in its localized stage) can mean a near 99% survival rate. The survival rate drops steadily in proportion to how deep and how far the cancer has spread at the time of detection, so regular screenings are very important.

Signs of Skin Cancer Around the Eyes

The areas surrounding the eyes are very delicate and sensitive areas of the face. Additionally, the eyes are a central feature on the face, and the appearance of the eyes are often a major cosmetic concern for patients as well. As such, early diagnosis of skin cancers in this area are particularly important in order to be able to effectively treat the skin cancer while still preserving normal vision, structure, function, and cosmetic appearance of the eyes.

Skin cancers can sometimes present as a distinct lump or bump in the area surrounding the eyes. However, there can sometimes be more subtle signs of irregular tissue growth that may signify the growth of a skin cancer in the affected area. Some of these other signs can include: areas of crusting, irregular pigmentation, areas of bleeding or ulceration, scar formation, changes to the normal eyelid architecture, loss of lashes or irregular lash growth, and/or the appearance of notching of the eyelid margin. In rare cases, skin cancers can also sometimes masquerade as more common eyelid conditions such as blepharitis, chalazia (styes), or other benign-appearing lesions. For these reasons, any irregular growth in the areas of the face surrounding the eyes should be thoroughly examined by an OculoFacial Plastic Surgeon, such as Dr. Lewen. Any lesions in this area will typically be photographed. In cases where there is a lower suspicion for a skin cancer, sometimes, areas may be observed over a period of time for any significant changes that may suggest growth or malignancy.

The definitive way to diagnose skin cancer is by biopsy. Very often, this can be done as a simple procedure in the office with little or no downtime. In cases of higher suspicion for skin cancer, a biopsy will be recommended to be performed and the specimen will be promptly sent to the lab for microscopic evaluation and diagnosis. After your lab result has returned, Dr. Lewen if there is a skin cancer present in the affected area, Dr. Lewen will review your treatment options in depth at the time of your visit.

Treatment of Skin Cancer

While certain types of skin cancer in certain locations can be treated with options such as cryotherapy (freezing), lasers, and topical chemotherapy medications, other forms require surgical excision. Frequently, due to the sensitive nature of the tissue around the eyes, skin cancers in this area are typically much better treated with surgical excision and reconstruction of the affected area.

Often, the best way to accomplish skin cancer excision while preserving as much normal tissue as possible in more sensitive or highly visible areas of the face/body is to have a Mohs surgery performed. A Mohs surgeon is a dermatologist who has received additional specialized surgical training in the removal of skin cancer lesions, along with pathology training in the microscopic evaluation of cancer tissue. After the skin cancer is removed completely and the margins of the area are determined to be free and clear of cancer as well, the reconstructive portion of the surgery must be performed. Sometimes, the Mohs dermatologist can simply close the wound left after excision, but this may not always yield the best cosmetic or functional result.

Particularly when dealing with skin cancers in the more delicate areas around the eyes, the brows, the cheeks, and the other surrounding areas of the face, appropriate repair of a wound after Mohs surgery is extremely important to ensure adequate protection of the surface of the eye, and the preservation of vision. If delicate care is not taken during reconstruction, scarring and other deformities can sometimes result, which can potentially cause significant compromise to the health of your eyes, the ability to close your eyes normally, the appearance of your eyes and the symmetry of your face, and your vision, as well as other issues. An OculoFacial Plastic Surgeon is a sub-specialist who is board-certified in Ophthalmology, and has completed advanced, sub-specialty fellowship training in the various plastic surgery and reconstructive procedures involving this delicate area of the face. For this reason, it is strongly recommended to have an OculoFacial Plastic Surgeon, such as Dr. Lewen, involved in the reconstruction of such areas of the eyelids and face after skin cancers are adequately removed. Dr. Lewen will ensure that your appearance is restored, and that your function is maintained as close to normal as possible.

The Experience

Whether your biopsy was performed by Dr. Lewen or another physician, Dr. Lewen will make significant time during your consultation visit to review all of the treatment options for your skin cancer. If your biopsy was performed by another physician, we ask that you please try to bring a copy of the pathology report with you on the day of your consultation. Dr. Lewen will perform a full examination of the affected area, and he will make time to answer any questions that you may have. He will also review the expected surgical plan with you at this time.

Next, Dr. Lewen will refer you to see a Mohs dermatologist who specializes in the removal of skin cancers. Dr. Lewen works closely with several Mohs dermatologists in the south Florida area. The office staff will assist you in scheduling your appointment to see a Mohs dermatologist, and will also help you to coordinate your surgery. You will be given detailed instructions including any pre-surgical testing that may be required. Following Mohs surgery for skin cancer removal, the reconstruction of the affected area is typically performed within 1 to 2 days after the skin cancer is completely excised, and the margins are determined to be free and clear. Of course, the complexity of the reconstruction required will depend on the exact size, depth, extent, and location of the defect, and also if there is involvement of other neighboring structures, such as the tear duct. Dr. Lewen performs most of his Mohs reconstruction surgery in accredited, ambulatory outpatient surgical centers, where patients can receive anesthesia from a board-certified anesthesiologist if required. We understand that the experience of having a skin cancer on your face can certainly cause some anxiety. Our team is here to help you as much as possible, and we will ensure that your entire surgical experience is coordinated seamlessly in order to ease you through this process.

As an OculoFacial Plastic Surgeon, Dr. Lewen has extensive experience in reconstructing areas of the eyelids and face after skin cancer removal. It is this experience and focus that will enable you to maximize your cosmetic result while preserving the structure and function of your eyelids and face, particularly that which is vital to the health of your eyes and vision. Depending on the complexity of your surgery and your individual health, your healing time after Mohs reconstruction surgery may vary considerably. Dr. Lewen will review his expectations for your healing with you at the time of your consultation, as well as during your post-operative appointments. Occasionally, secondary surgical procedures may be required for reasons such as to modify excessive scarring, to improve the position of the eyelid(s), to correct tear duct abnormalities, to resect recurrent skin cancer, or for other issues.

Sited information and illustration labeled Figure 2 is from: