Your eyelid has a skin lesion that looks like a tumour and requires surgery to determine its exact nature by microscopic analysis and to treat it.
This sheet contains information on the operation that is proposed to you, its results and possible risks.
Why are you being offered this operation?
If the tumour in your eyelid is left untreated, it will develop as follows:
– If it is a benign, non-cancerous lesion, it may either increase in size very slowly or stop growing and remain at its current size and appearance. – In the case of a malignant lesion, a cutaneous cancer of the eyelid, it will progressively increase in size both on the surface in a visible way, but also in depth in an insidious way because it cannot be detected on direct examination.
The tumour extension may progressively infiltrate the entire eyelid.
In addition, the tumour may extend deep into the eyeball, the bony walls of the orbit surrounding the eye and the eyelids, the sinus cavities and the anterior part of the skull base and the brain.
Some types of cancerous tumours, such as squamous cell carcinomas and melanomas, can also spread beyond the eyelid: – to the lymph nodes, – to the liver, lungs and bones, and become generalised.
The treatment of an advanced malignant tumour is therefore more difficult, more mutilating and the possibilities of definitive cure are more uncertain.
Moreover, the external appearance of your tumour only allows you to orientate the diagnosis, and only an anatomo-pathological examination (analysis under the microscope) will allow you to know the exact nature of the tumour (benign or malignant), and its evolutionary potential by identifying the type of cell(s) affected by the abnormal proliferation process.
The operation proposed by your ophthalmologist is therefore intended to :
– Either to surgically remove your entire tumour and have it analysed.
– Or to take one or more samples called biopsies, if the complete surgical removal of your tumour does not seem possible, or not desirable. The analysis of these biopsies will then allow us to indicate the most appropriate treatment for your situation: radiotherapy, chemotherapy and/or extensive surgery carried out at a later stage.
Procedure: The operation will be performed as an outpatient surgery or as a short hospital stay. The patient lies on his back in the operating theatre. The operation will require an anaesthetic to avoid pain: – either a local anaesthetic, by injection of an anaesthetic product into the eyelid, – or a general anaesthetic.
– Depending on your case, the operation will include one or more of the following steps: – Removal of the tumour associated or not with the partial or total removal of the eyelid over its entire thickness (with in this case, partial or full removal of the ciliary margin).
– Reconstruction of the eyelid by grafts (of skin, mucous membrane, cartilage) which can be taken from the eyelids, the face, behind the ear, or from the oral cavity.
It is not always possible to assess the extent of the tumour during the operation, which will be determined by microscopic examination of the removed part: in the event of partial or incomplete removal, you will be offered an appropriate treatment.
The stitches will be removed by your surgeon during a follow-up visit after the operation.
If the situation of the tumour or the need for a large removal justifies it, the surgical procedure may involve the path of the lacrimal canaliculi or the lacrimal sac. This will result in tearing (more or less permanent flow of tears on the cheek) which may be permanent.
What are the intra- and post-operative incidents and accidents?
Incidents may occur in relation to the need to remove as much tumour tissue as possible: haemorrhages, in principle treated immediately by cauterisation or ligation, nerve sections which may result in the insensitivity of a skin area in the vicinity of the operated eyelid, sections or partial removal of eyelid muscles which may result in paralysis of their usual movements (opening and closing).
Usual postoperative evolution and complications: The operated eyelid may be inflammatory, swollen and painful for the first few days. These symptoms usually subside with the medication that will be prescribed to you as a preventive measure.
The healing process will progressively settle and reduce the relatively unsightly aspect of an operated eyelid. This process is sometimes accompanied by a retraction of the fibrous armature of the eyelid which can lead either to a retraction of the ciliary rim towards the back of the eyeball (entropion), or, on the contrary, to a cicatricial attraction of the eyelid upwards for the upper eyelid, and downwards for the lower eyelid (ectropion) likely to hinder the occlusion of the eyelids, and unsightly.
These complications, sometimes unavoidable after wide resection, require in some cases one or more plastic surgery procedures aimed at re-establishing a palpebral “curtain” that is both aesthetic and functional. However, it is not possible to guarantee the restoration of a perfectly normal eyelid appearance, especially after wide surgery, and given the relatively unpredictable evolution of the scarring process itself.
Infection of the operated eyelid is rare, but its occurrence will have to be treated with antibiotics – local or general – and possibly with a reoperation.
The post-operative period will essentially be conditioned by the result of the examination of the surgical specimen, which will be given to you a few days afterwards: depending on the type of tumour process and its characteristics, the monitoring that will be proposed to you will vary considerably:
– in the case of a benign tumour, it will be limited to monitoring the healing process,
– in the case of a malignant tumour :
– regular monitoring of the operated eyelid will be necessary to detect a possible local recurrence of the tumour,
– complementary treatments to surgery (radiotherapy or chemotherapy) will be discussed in a multidisciplinary meeting,
– Periodic check-ups will be carried out in the case of a tumour with a potential for distant dissemination (metastases).
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The ophthalmology secretaries and Dr. Qin’s team are available to answer all your questions and requests for information in order to make the best choice. I will be pleased to welcome you at one of the 5 sites.