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inSIGHT

Abstract

Eyelids are the thinnest, most sensitive skin we have and can easily be damaged by sun exposure. This is evident given that 5 - 10% of all skin cancers occur on the eyelid, and over half of these occur on the lower eyelid1. Most of such cases are basal cell carcinomas, which are slow-growing cancers that arise from the basal cell layer, the deepest part of the epidermis. If left untreated or improperly treated, these tumors can extend into adjacent tissues and bone, or recur. Squamous cell carcinomas can also occur on the lower eyelid, although they represent only a minority of cases. These arise from the squamous epithelium, a layer of scale-like cells found in the superficial epidermis and they can also spread and grow into deeper layers of the skin. Cancers of the lower eyelid are usually treated with surgical excision and evaluation of the surgical margins. This can be done with frozen sections or Mohs surgery. With frozen sections, the margins are evaluated by a pathologist at the time of surgery. Mohs surgery is a procedure that has been around for decades and is done by a specialized dermatologist. It involves excising the carcinoma layer by layer until it is fully removed. The nonsurgical alternatives are cryotherapy and radiotherapy. They are less invasive, avoid surgery, but have a higher rate of recurrence compared to surgery2. When a lot of tissue needs to be removed, the result is the unilateral loss of a portion of the lower eyelid full thickness. This is also known as a lower eyelid defect, which can be repaired by an oculoplastic surgeon. The eyelid consists of the anterior lamella, which includes the skin and orbicularis oculi muscle, and a posterior lamella, which includes the conjunctiva and tarsus (Figure 1). This anatomy is important to understand when repairing the lower eyelid defects.

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