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MultiPurpose

Cancer


Skin Tumors

The face and eyelids are very common locations for skin cancer. Many times skin cancers may appear as benign growths. Other times they can develop cancerous characteristics over a relatively short time. Potential warning signs are new growths with elevated, irregular borders, coloration, indentation, or ulceration. If skin cancer forms along the edge of the eyelid it often causes the eyelashes to fall out. The Eye plasty center uses state of the art technology. The area of concern is first biopsied to determine if it is in fact a cancer. If the biopsy is not cancerous, no further treatment is required. If the biopsy is cancerous, most cancers are then removed using various techniques preserving the most normal tissue around the eyelids and face. The major added value of The Eye plasty center after the cancer is removed. It is paramount that our patients not only obtain cure of the cancer but also achieve the best possible post reconstruction function and facial appearance. Dr. Saurin has extensive experience in performing both reconstructive and aesthetic surgery and each comes into play in reconstructing the defect left by tumor removal in a way that maximizes facial appearances.

  • What is the most common type of skin cancer?

    Basal cell carcinoma is the most common type of skin cancer followed by squamous cell carcinoma. Melanoma is less frequent but it is more likely to metastasize, so diagnosing melanoma early is important. In Indian skin, Sebaceous gland cancer is also relatively more common.

  • What causes skin cancer?

    Risk factors we are born with include: fair complexion, light colored eyes, blond or red hair, tendency to burn instead of tan, family history of skin cancer, and a weakened immune system. People who have had a prior skin cancer are much more likely to form another. The number one modifiable risk factor for skin cancer is sun exposure.

  • How does sun exposure contribute to skin cancer?

    Ultraviolet light damages the skin cells and causes them to become cancerous.

  • Is all ultraviolet light bad?

    Yes. Ultraviolet light can be divided into the A rays and the B rays. The B rays are more responsible for causing skin cancer but the A rays can also act as tumor promoters. The A rays actually penetrate deeper into the skin are more responsible for the loss of skin elasticity and premature aging of the skin seen in those with chronic sun exposure. It is important to choose sunscreen that blocks out both A and B rays.

  • Is it true that one really bad sunburn can cause skin cancers later in life?

    Yes.

  • When do most people get sun damage to the skin?

    Most sun damage occurs prior to the age of 18. It is very important that children be protected from the sun and that sunburns not be an acceptable in children.

  • Is skin cancer becoming more common?

    Yes. More than one million skin cancers are diagnosed each year. All types of skin cancer are becoming more frequent in part to depletion of the ozone layer of the atmosphere.

  • How is skin cancer diagnosed?

    The important first step is that the patient or the doctor suspect that a lesion might be a skin cancer. The lesion is then biopsied and sent to be examined with a microscope. If the lesion is a skin cancer it will require further treatment to remove it completely.

  • What changes on my skin should I suspect are skin cancer?

    Skin cancer does not hurt. Sometimes it will be elevated about the surface of the skin but often is flat. A scab that falls off to reform in the same place is very often a skin cancer. Any skin abrasion that does not heal is very suspicious for a skin cancer. Pigmented lesions or moles that are Asymmetrical, have an irregular Border, have different shades of brown black or tan Color, have a Diameter of > 6mm, or Evolving (changing) over time are suspect of being melanoma.

  • What can I do to prevent skin cancer?

    Avoid sunburns or excess sun exposure, avoid tanning booths, and protect your children from the sun! Use broad spectrum SPF 45 or greater sunscreen and apply it liberally and frequently. The stated SPF (Sun Protection Factor) is applicable at the time of application, but decreases exponentially afterwards. Hence, care should be taken to re-apply the sunscreen after two hours, on continued sun exposure. Wear sunglasses and a broad brimmed hat when in the sun.

  • I have a history of sun exposure; what can I do to prevent this from being a problem.

    As with most things you cannot take back what you did when you were young. However, you can assist by bringing any suspicious lesion to the attention of your primary care doctor, a dermatologist, or one of the doctors at the Eye Plasty Center. Often a skin cancer is noted by the way it changes with time. It is very useful to bring to the attention of a doctor that a skin change is getting bigger, sometimes bleeds, or sometimes forms a scab. Skin cancers are much easier to treat and less likely to leave a scar when they are small when diagnosed.

  • What role do the doctors at the Eye Plasty Center play in diagnosing and treating skin cancers?

    Your doctors can biopsy any suspicious lesion. I expertise in reconstructing the defects left after skin cancer has been removed from the eyelids, face, or trunk. Our goal is to cure you of the cancer and to restore normal appearances.

    These common forms of facial cancers and hundreds of other less common forms can be corrected by Dr. Saurin with an evaluation and subsequent surgery. If you are looking for an expert in diagnosing, evaluating and treating your facial cancer, look no further than The Eye Plasty Center. Remember, cancer can kill! Evaluating a facial lesion suspiciously right at the beginning can save your life.

Basal Cell Carcinoma

The most common type of eyelid cancer is basal cell carcinoma. Most basal cell carcinomas can be removed with surgery. If left untreated, these tumors can grow around the eye and into the orbit, sinuses and brain. Basal cell carcinomas are more commonly found on the lower eyelids and almost never spread to other parts of the body (metastasize).

Symptoms

Patients with basal cell carcinomas most commonly notice a reddish nodule slowly forming on their eyelid. The tumor is most commonly found on the lower eyelid, followed by the medial canthus (toward the nose) and can occur on the upper eyelid. Eyelash loss (around the tumor) suggests that a tumor is malignant.

Less commonly, basal cell cancers can be pigmented or present without any nodule at all. When the tumor does not make a nodule and grows within the eyelid, it can induce pulling of the eyelid (away from the eye). These cases (morpheaform variant) are much more difficult to treat because its edges are harder to define.

Diagnosis

Though small tumors can be photographed and followed for evidence of growth (prior to biopsy); once your eye cancer specialist suspects basal cell carcinoma, most eye cancer specialists will suggest a simple wedge eyelid biopsy. This specimen is sent to the pathologist to confirm the diagnosis prior to complete removal of the tumor.

Wedge biopsies can be performed in the doctor's office, or in the operating room prior to definitive treatment.

Treatments

Once the diagnosis is confirmed by the pathologist, complete excision will be recommended. Both techniques require that the surgeon continue to remove the tumor until the margins (edges) are negative (free of tumor). Unlike most areas of skin, the eyelids are a complex functional apparatus that requires special reconstruction techniques.

Most basal cell carcinomas can be cured when they are small. Unfortunately, some patients choose to ignore or deny the existence of these tumors. Those patients allow their tumor to invade behind the eye and become difficult or impossible to remove. In these cases radiation and chemotherapy may be offered to control or destroy the tumor.

Squamous Carcinoma

Squamous carcinomas of the face and the eyelid can locally invade the orbit and sinuses, but rarely metastasizes. It is the second most common malignant eyelid tumor, but is 10 times less common than basal cell carcinoma. It is the most common conjunctival cancer and may spill over onto the eyelid.

Symptoms

Patients with squamous eyelid tumors can have symptoms that range from the appearance of a hypervascular flat reddish or flaky lesion on the eyelid skin to a thickened well-demarcated reddish, flat tumor surrounded by inflammation (with or without scaling from its surface).

Diagnosis

Squamous carcinoma of the eyelid should be photographed at baseline. These lesions can remain unchanged (for years), then invade into the dermis and grow. A simple wedge biopsy can be performed in the office setting and sent for pathologic evaluation. Once the diagnosis of squamous carcinoma is biopsy proven, definitive treatment is needed.

Treatments

Like basal cell carcinomas, squamous cell cancers of the eyelid rarely metastasize. They can grow around the eye into the orbit, sinuses and brain. Therefore, early intervention with complete excision is warranted. Dr. Saurin will perform a planned excision to remove the entire tumor along with a small safety zone of normal appearing tissue from the edges of surgical wound (margins). When the orbit and sinuses are not involved, local excision is usually curative.

Extension into the orbit and sinuses typically requires more extensive surgery (exenteration, sinusectomy) with subsequent radiation therapy.

Sebaceous Carcinoma of the Eyelid

Sebaceous carcinoma arises from the glands within the eyelids, caruncle or eyebrow. They are more commonly found on the upper eyelid and in middle-aged patients.

Sebaceous cell carcinoma is suspected due to evidence of eyelash loss and the formation of a yellow-nodule. This tumor can also present as a persistent (months) non-responsive redness of the eye or conjunctivitis. In these cases, a high index of suspicion for sebaceous cell carcinoma will lead to biopsy and the diagnosis. Once sebaceous carcinoma is suspected a biopsy is warranted. Before surgical biopsy, Dr. Saurin informs the pathologist of this possible diagnosis so the specimen can be processed appropriately.

Symptoms

Sebaceous carcinomas are one of the rarest eye cancers and can look like a chalazion (stye – a swelling of the glands in the lid). Any conjunctivitis or chalazion that is not getting better after 3 months of observation, should be biopsied.

Diagnosis

Sebaceous carcinoma of the eyelid typically presents as a yellow-nodule in the upper lid. The tumor can cause eyelash loss and is not painful. This tumor can also present as a hypervascular conjunctival tumor and tends to spread along the conjunctival surface. The gold standard for diagnosis of sebaceous carcinoma is histopathologic evaluation on fresh tissue.

Treatments

Once the diagnosis is made, a metastatic survey (looking for other sites of cancer) is warranted. Sebaceous carcinoma can spread to regional lymph nodes (pre-auricular and cervical) as well as to lungs, brain, liver and bone. Published series have reported that the occurrence of metastatic disease was dependent on the size and location of the primary tumor and occurred in up to 27% of patients. Local tumor invasion of the lymph nodes, orbit or metastatic sites were associated with a poor prognosis for survival.

Treatment requires a COMPLETE resection. We use frozen section control to provide negative margins. Larger surgeries, cryodestruction and radiation may be required if resection is not possible. Exenteration (complete removal of the orbital contents is sometimes required for extensive or recurrent disease).

Malignant Melanoma of the Eyelid

Melanoma of the eyelid is a relatively rare tumor making up less than 1% of eyelid cancers. It typically appears as a pigmented thickening (tumor) of the eyelid or extension of pigment from the conjunctiva.

Symptoms

Malignant melanoma of the eyelid is distinguished from an eyelid nevus in that it can be variably pigmented, change color, bleed and/or grow. All pigmented tumors of the eyelid should be evaluated by an eye care specialist with experience with melanoma.

Diagnosis

All pigmented eyelid tumors should be photographed for comparison with future examinations. Patients should keep a copy of their baseline photographs.

Malignant melanoma of the eyelid is distinguished from an eyelid nevus in that it can be variably pigmented, change color, bleed and/or grow. Suspicious eyelid tumors should be evaluated by biopsy. A simple wedge biopsy can be sent for pathologic evaluation to aid in the diagnosis.

Treatments

If the pathologic diagnosis is malignant melanoma of the eyelid, a medical work-up is ordered to rule out metastatic spread to other parts of the body. If there is no metastatic disease, the tumor can be surgically removed (including large margins of normal appearing tissue). At the time of surgery, some doctors will also remove regional lymph nodes near the tumor (in order to determine if the tumor has locally spread).

Facial plastic surgery techniques are usually required to repair the defect caused by tumor removal.