Periocular Skin Cancer and the 2 Stage Surgical Procedure

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1 Periocular Skin Cancer and the 2 Stage Surgical Procedure Leicester Royal Infirmary Ophthalmology Department Information for Patients University Hospitals of Leicester NHS Trust

2 Introduction You have been diagnosed with a suspected skin cancer close to your eye, which may be a basal cell carcinoma (BCC) or a squamous cell carcinoma (SCC). Basal cell carcinoma (BCC), sometimes also known as rodent ulcer, is the commonest form of skin cancer seen. Sunlight exposure is known to be one factor that encourages this condition, so the most common site affected is the face, head and neck. However, it can occur at other sites on the body. Fair skinned people who burn easily in sunlight are more affected than those with darker skins, especially if they have spent long periods of time outdoors working or in recreation. Although it is a form of cancer, it is rare to spread beyond the skin. However, if left untreated it will gradually get bigger. It is therefore best to have it treated and entirely removed. Squamous cell carcinoma (SCC) is less common but more serious. It can spread to other areas of the body if it is left untreated for a long period; however this is unusual in tumours around the eye as they are nearly always recognised and treated while still small. Your doctor is recommending a two stage surgical procedure. 2

3 Procedure 1: Removal of the lesion This is usually done under local anaesthetic as a day case. The tumour is removed with a clear margin of normal looking tissue and sent to the laboratory to confirm the diagnosis and to determine that the entire lesion has been excised. This process takes between four and eight days. During that time there will be a large firm pad covering the defect which will in most cases also cover the eye. This means that driving is not allowed and wetting the pad (swimming or hair washing) should be avoided. Procedure 2: Repair of the defect This is usually done approximately a week after procedure 1. Procedure 2 is usually done under local anaesthetic as a day case but larger defects may be repaired under general anaesthetic. The surgeon will discuss with you the method of repair after assessing the size of the defect. It may involve moving a flap of healthy skin from close to the wound, or placing a graft using healthy skin from elsewhere on the body. Skin grafts can usually be harvested from the top eyelids or around the ears, but large grafts may need to be taken from other parts of the body. If a skin graft is used, the pad needs to be reapplied for a further period of between three and seven days. In all cases the wound should be kept clean and dry until fully healed, which may take up to six weeks. 3

4 Procedure 2: Repair of the defect (continued) In some tumours involving large parts of the lower eyelid the defect is best repaired by stitching the eye closed for a while. A further small operation is then needed to reopen the eye after a few weeks. The surgeon will explain if this is likely in your case. Occasionally no procedure 2 is required, and the wound area is allowed to heal by itself. This is called laissez faire. What happens after the procedures? You will be seen in the outpatient clinic approximately one week after procedure 2 for further wound care and dressings as appropriate. If the report from the laboratory shows that not all the tumour has been removed, the surgeon will undertake a further excision before completing the repair. Small areas can be examined within one to two hours and the surgery can be completed that day. Residual tumour requiring a large excision will need to be processed using the longer method and a third date for surgery will be arranged. 4

5 How successful is the procedure? Our data show that excising skin cancers in this way reduces the risk of the tumour recurring from around 25% to less than 1%. 5

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8 If you would like this information in another language or format, please contact the Service Equality Manager on Haddaad rabto warqadan oo turjuman oo ku duuban cajalad ama qoraal ah fadlan la xiriir, Maamulaha Adeegga Sinaanta Eĝer bu broşürün (kitapçıĝın) yazılı veya kasetli açıklamasını isterseniz lütfen servis müdürüne telefonundan ulaşabilirsiniz. Produced: November 2009 Review: November 2011 (Heald) KR EYE