What is Periocular skin cancer?

Skin cancer involving the skin of the eyelid or adjacent face is called a Periocular skin cancer. Eyelid skin cancers occur most often on the lower eyelid, but may be found anywhere on the eyelid margins, corners of the eye, eyebrow skin, or adjacent areas of the face. Usually, they appear as painless elevations or nodules. Occasionally, the eyelashes are distorted or missing. There may be ulcerations of the involved area, along with bleeding, crusting, and/or distortion of the normal skin structure. Such findings need to be evaluated and may require a biopsy to confirm the diagnosis of skin cancer.

What are the common periocular skin cancers?

The most common types of skin cancers are basal cell carcinoma followed less commonly by squamous cell carcinoma. Both types enlarge locally and usually do not spread (metastasize) to distant parts of the body. However, with time, if not completely removed, either type will invade adjacent structures. It is important to know that basal and squamous cell carcinomas are relatively slow growing. Thus, when detected early and treated in a prompt and appropriate manner, there is a better chance of removing the tumor completely and minimizing the amount of tissue affected by the carcinoma.

Sebaceous gland carcinoma and malignant melanoma are more serious forms of skin cancer because they may spread (metastasize) to other parts of the body. They are rare forms of lid cancers. These types of skin cancer require prompt, aggressive treatment because of the threat of early spread.

What is Basal Cell Carcinoma?

Basal cell carcinoma (BCC or Rodant Ulcer) is the most common form of skin cancer. Over 30,000 new cases of BCC’s are reported each year in the U.K. Fortunately it is a very slow growing form of skin cancer and rarely spreads to other areas or organs in the body. If left untreated, BCC’s can disfigure, especially on the face, therefore early recognition and treatment is important

BCC’s are caused by long-term exposure to sunlight and frequently occur on sun exposed skin, such as the face, scalp, ears, hands, shoulders and back. The white adult population is at risk of developing BCC’s, although most at risk are outdoor workers, sailors and the very fair skinned. BCC’s are frequently seen in persons aged over 50 years, but a greater number of younger adults are developing this form of skin cancer.

What Are The Early Warning Signs?

If you develop a skin lesion or soreness that fails to heal within 4-6 weeks and has two or more of the following features SEEK MEDICAL ADVICE:

BCC’s frequently appear as an open sore or ulcer. It may bleed or crust but does not heal.

BCC’s can look like a red patch on the skin which may be itchy, painful or crusty. Sometimes no symptoms are felt, but the lesion does not heal or fade.

A smooth raised growth can appear with an ulcer in the centre. These BCC’s can be flesh coloured, pink, shiny, red or pigmented like a mole.

BCC’s can also look like a firm nodule in the skin. These, too, can appear flesh coloured, pink, shiny, red or pigmented like a mole. BCC’s can take on the appearance of a flat scarred area in the skin. This area appears pale or white compared to surrounding skin and may have an ulcer or indentation in the centre. This form of BCC can grow more quickly, making the affected skin look taught and shiny.

Remember Basal Cell Carcinomas are Curable
Recognise the early warning signs.

How are BCC’s Treated?

There are two very important principles in the management of eyelid skin cancers : complete removal and reconstruction. Complete removal of the tumor is critical to minimize the possibility of recurrence, which is even more difficult to manage. It is best dealt by Oculoplastic Surgeons.

The surgeon may remove the tumour and have a pathologist check the tissue margins (“frozen section”) to be sure the tumour is completely removed. In another method, a surgeon excises the tumour in a special way (“Mohs technique”) to ensure total removal. More commonly, the surgeon may remove the tumour and directly reconstruct the resulting defect either on the same day or within the next 48 hours.

Once the tumour has been completely removed, reconstructive surgery is usually necessary. Occasionally, the wound can heal on its own through a process called “granulation.” More commonly, reconstructive surgery is performed to make a new eyelid or repair the defect. Many excellent techniques are available to reconstruct almost any surgical defect. The operation will be specifically tailored to the defect that is present following removal of the tumour. Regardless of technique, the goals remain the same: to reconstruct the eyelid so that it functions properly, protects the eye, preserves vision, and has a satisfactory cosmetic appearance. Any form of therapy for eyelid skin cancer will leave a scar. However, an effort is always made to minimize scarring and obtain optimal cosmetic results. After surgery, the healing process may take six months to one year.

What other precautions do we need to protect ourselves in future?

If you have had one BCC it is likely others will develop over the years. Examine your skin every 6-12 months for early warning signs. Look and feel for any changes in your skin in the rest of the body. Ask your partner to examine your back, neck, ears, or scalp.

Alternatively, a mirror can be used to examine these areas. Seek advice from your GP.

Wear protective clothing and wide brimmed hats when outdoors. These will protect the skin areas most at risk. Wear 100% UV protective sunglasses as the skin surrounding the eyes is vulnerable to BCC’s.

Avoid sunshine during the mid-day hours if possible. High factor sunscreen (SPF 15+) is vital. Apply them before going out in the sun and re-apply every 2-3 hours, or more frequently if perspiring or swimming.

Advise others, especially family and friends, to protect themselves. Carry out annual whole body checks.