Ectropion from eyelid tumour incompletely excised

Ectropion or pulling down of the eyelid can be very distressing.  In my previous blogs, I have talked about how it can cause watering eye, redness and irritation.  However, I have not emphasised the cosmetic defect that a lower lid ectropion causes.  The cosmetic defect can be very upsetting to a patient, especially if it is just on one side and looks asymmetrical. It is particularly unpleasant if there has been a scar in the lower lid, which has pulled the lid outwards and downwards.  This often gives an irregular contour to the lower lid and looks very unsightly, as well as being uncomfortable.
I have had two patients recently who have been referred to me having had basal cell carcinomas excised from their lower lid and upper cheek area.  One accepted the treatment about three years before and had come to me for revision of the ectropion scar across the tear trough and down the cheek that was causing the ectropion.  However, in her case, I found that she had a recurrent tumour in the scar, as she had to have Mohs micrographic surgery to remove that cyst and then complicated reconstruction of the eyelid, cheek and the tear duct afterwards.  So I take very seriously any patient that has had previous skin tumour excision on their cheek or lid that presents to me with a visible scar and ectropion as there may be residual tumour there that has to be dealt with.
The second patient was more recently, and she had also had a basal cell carcinoma removed from her lower lid area and unfortunately, it had not all been removed. Then on top of that, she got a horrible vertical eyelid and cheek scar, which caused her to have an unpleasant lower lid ectropion which was like a V shape going down and a sorely sore eye.  She also required further excision by Mohs micrographic surgery together with excision of the scar and repair of the eyelid and cheek with skin flaps and grafts.
These two cases illustrate the importance of not ignoring your ectropion.  You may assume the ectropion is just due to a scar, but if the scar is there because of the previous tumour, there may be tumour recurrence.
Also, you may assume that the ectropion is there because of old age, but there might be another cause that needs more a serious approach to it such as excluding the presence of a skin tumour that requires biopsy and excision.