Summary
Skin cancers around the eyelid are common, most are basal cell carcinomas (BCCs), which are slow-growing and almost never metastasise but need removing because they grow locally and can damage important structures. Less commonly, squamous cell carcinoma, sebaceous carcinoma or melanoma occur in this region.
I work as part of the periocular oncology MDT at Portsmouth, where every case is reviewed by ophthalmologists, dermatologists and pathologists to plan the best treatment.
Who is this for?
Typical presentations include:
- a slow-growing pearly nodule with surface blood vessels,
- an ulcer or scab that doesn’t heal,
- thickening, crusting or distortion of the eyelid margin,
- loss of lashes from a particular area.
If you or your GP is concerned about an eyelid lesion, urgent assessment is straightforward.
Is this funded on the NHS?
Yes, and unlike the rest of eyelid surgery there is nothing local about it. Removing a lesion that might be a cancer is not restricted by any integrated care board in England, and it runs on the urgent pathway rather than the routine one, so none of the criteria and thresholds that govern other eyelid operations apply here. Where the funding rules do bite is elsewhere, and that is the subject of a separate note: is eyelid surgery funded on the NHS?
What the procedure involves
Treatment is in two stages:
- Excision with margin control. Either conventional excision with frozen-section margin analysis, or (for higher-risk tumours) Mohs micrographic surgery performed by a dermatology colleague.
- Reconstruction of the defect. The technique depends on the size and site, options range from simple direct closure or a Hughes tarsoconjunctival flap, through skin grafts and rotation flaps, to more complex Cutler-Beard or median forehead flaps for the largest defects.
Most procedures are performed as a day case under local anaesthetic with sedation. Some larger reconstructions need a brief admission.
Recovery and what to expect
- The eye is often padded for 24 hours after surgery.
- Swelling and bruising peak at 48 to 72 hours.
- Sutures are removed at 1 to 2 weeks depending on technique.
- For two-stage procedures (e.g. Hughes flap), a second ‘opening’ procedure is performed 4 to 8 weeks later.
Risks and alternatives
Risks include bleeding, infection, recurrence of the cancer, eyelid malposition, scarring, and (rarely) corneal exposure problems. Long-term cure rates for primary BCCs of the eyelid are above 95% with appropriate surgical management.
Non-surgical alternatives (radiotherapy, topical therapies) have a role in carefully selected cases and are discussed at the MDT meeting.