Health Care As It Should Be April 2013

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The Blink Of An Eye

The Facts About Eyelid Cancer

Hats, sunglasses and sunscreen are crucial elements in the fight against eyelid cancer.
Hats, sunglasses and sunscreen are crucial elements in the fight against eyelid cancer.
Eyelids are vital structures many of us take for granted, yet we often forget about them when it comes to sun protection. Eyelid cancer accounts for up to 10 percent of all skin cancers. “The skin of the eyelid is very fragile and easily injured by the sun,” says Jennifer Hui, MD, FACS, Board Certified in Ophthalmology. “Most people forget about their eyelids when applying sunscreen and many go out without hats or sunglasses."

Symptoms and Types of Cancer
Sun exposure is cumulative — the older we get, the more likely we are to develop eyelid cancer. People with fair skin, and blonde or red hair and light eyes are particularly at risk.

The lower lid is affected most often by eyelid cancer. The corner of the eyelid closest to the nose is the second most common area, followed by the upper eyelid.

Like other skin cancers, basal cell carcinoma is the most common cancer to affect the eyelid. “You may see a little nodule or lesion that gets larger. It will usually be pearly with visible blood vessels in the center,” says Dr. Hui. “It may have crusting or bleeding at the site. You may also notice a loss of eyelashes in that area.”

A squamous cell carcinoma will progress more rapidly with a non-healing area in the center. More rarely, a melanoma will occur which most often appears as a dark spot. “Ideally, people should be aware of any lump or bump anywhere on their eyelid, especially on the margin in between the lashes,” notes Dr. Hui.

The standard of care for eyelid cancer is Mohs microscopic surgery by a dermatologist to remove the lesion, followed by repair of the area by an ocuplastic surgeon.

“During the Mohs procedure, a Mohs-trained dermatologist takes the cancer off and immediately looks at the lesion under a microscope to make sure they removed all of the cancer, checking to see if they need to go back and remove more,” explains Dr. Hui. “This tissue-sparing approach is preferable because there is so little redundant tissue in the eyelids. Once the lesion is removed, the area can be repaired within hours or on the following day.”

Radiation and topical treatments are available but not optimal. “Topical treatments can be very irritating and I don’t feel there is a role for radiation because of the damage it can cause to surrounding tissue,” says Hui. “Excision is by far the treatment of choice.”

Preventing eyelid cancer is relatively easy but does require self-discipline. Sunscreen is a must. An SPF of 30 is recommended in desert areas like the Coachella Valley. “Find a sunscreen you will wear and reapply it regularly,” says Dr. Hui. “You always want the sunscreen to be directly in contact with your skin for best protection. When you apply sunscreen, you should see it coating your skin as you massage it in. Also, don’t forget to reapply.”

Sunglasses are also helpful in preventing eyelid cancer. Dr. Hui recommends sunglasses that wrap around the eye and block the sun completely.