People of older age, with fair skin, blue eyes, red or blond hair with Scottish, English, Irish or Scandinavian ancestry are most at risk to develop a basal cell carcinoma of the eyelid. Significant sun exposure and sunburns in the first 20 years of life, cigarette smoking, and a prior history of basal cell carcinoma also increase your risk.

While basal cell carcinomas come in several different forms, nodular basal cell carcinoma is the most common clinical lesion. The growths are described as a firm, raised, pearly nodule with central ulceration and associated increased vascularity (telangiectasia).

A biopsy is performed in the office and the specimen sent for pathology review. Prior to biopsy, the lesion is photographed as the biopsy site can at times heal well enough that the original area is difficult to identify once it has healed.

An eyelid basal cell carcinoma needs complete tumor excision, with pathologic proof of clear margins, and careful reconstruction. I prefer to utilize a team approach and schedule my patients with a Mohs dermatologist to excise cancer in their office under local anesthesia. Utilizing a Mohs micrographic technique, complete tumor removal is possible while creating a small tissue defect.

The physician numbs the skin, removes any suspicious tissue along with some normal tissue and examines the specimen under the microscope. If any tumor remains, they carefully excise more tissue in a very conservative manner, process the specimen and review the tissue under the microscope. The process is repeated until the entire cancer has been removed. The patient is then patched and is driven to the surgery center where I repair the defect under sedation. As an oculoplastic specialist, I have the training and experience to meticulously reconstruct the defect. The goal is to preserve proper lid position which will then protect the eyeball and the vision.