The oculoplastic surgeon will first examine the eyelids and face. The suspected tumour is examined macroscopically (with the naked eye) and then under magnification (using a slit lamp). The suspected BCC is then measured, photographed, and a drawing of its location on, or near, the eyelids is done.
Particular attention is taken to look for telangiectactic blood vessels, pearly edge and ulceration, typical of a nodular BCC. Not all BCCs are nodular and can be difficult to detect, therefore, biopsy is essential. A more insiduous form of BCC is called a morpheic BCC, which is almost flat and spreads laterally and microscopically across the eyelid.
The treatment of a BCC depends on its type, size and location, so a biopsy is first performed under local anaesthetic. Once the diagnosis and type of the suspected BCC is confirmed, a treatment plan is drawn up.
Oculoplastic surgeons are trained to diagnose and treat skin cancer on the face, eyelids and periocular region and to undertake peri-orbital reconstructions. They work closely with consultant dermatology colleagues, who will use Mohs’ micrographic surgery to completely remove the BCC. Afterwards, the oculoplastic surgeon will do a face, eyelid or periocular reconstruction as necessary to restore the normal appearance and function of the face and eyelids. This may involve direct closure, flaps or grafts.
Surgical Treatment of a Basal Cell Carcinoma
The main advantage of surgical excision is that excision margins can be examined to check the cells for tumour clearance.
The aims of treatment are to:
1. Establish the diagnosis clinically and by a small incisional biopsy
2. Completely excise the tumour (often using Mohs’ micrographic surgery)
3. Perform an oculoplastic reconstruction to maintain a normal appearance and function.
Different surgical techniques can be used to treat BCCs. One treatment is to shave, curettage and cauterise the tumour, another is to freeze off the BCC with liquid nitrogen (cryosurgery). The BCC can also be excised with a 4mm margin of normal tissue.
At Clinica London, we usually do an incision biopsy to establish the diagnosis and then use Mohs’ micrographic surgery in order to completely eradicate the tumour (this stage is done by the dermatologist) and finally we carry out the delicate eyelid and peri-orbital reconstruction, using specialist oculoplastic techniques.
Mohs’ micrographic surgery is a newer treatment than direct excision with a 4mm margin. Its advantage is that it looks at cells in the base of the tumour, not just at the edges, and insures that the entire tumour is removed in one setting.
The results with Mohs’ micrographic surgery are very good.