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Tiease D. Deutsch
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Health & Beauty Advice
by
Tiease D. Deutsch
Eyelid cancer & the Fashionista
For most Fashionistas your eyes & their appearance are your claim to fame. Logical for the sighted of us to panic at the thought of Eyelid Cancer & the possibility of deformaty & blindness. Any cancer is a unpleasant scary thought; Then to take it to the next level & combine blindness, cancer, scarring & possibly death is intimidating. Unfortunately Eyelid skin cancer is a fact of life although most Fashionistas are blissfully unaware of its danger & consequences.
Regretably when it comes to any form of cancer ignorance will not save you. With adulthood comes reality you must acknowledge it, take preventative actions to avoid it, early detect it, dissect it, and earnestly understand it in order to conquor it.
Eventhough I am a nurse I understand the need & necessity to discuss any disorder in simple, precise words so that the everyday individual can understand the message I am attempting to convey to them. I believe the best way to approach a medical disorder is to provide my readers & clients with clear definitions, explain any pertinent medical terms so all can comprehend the message I'm trying to get across to you.
I approach the topic of "Skin Cancer of the Eyelid" in a noncomplex manner because I don't appreciate it when people talk down to me & I won't do this to my readers. My goal is to informed and education-not to humilitate. Now we shall begin.
Our skin is the largest organ of the human body; What the public notices about you instantly; your skin is our body's first defense against germs & infection. It is common that health problems associated with our skin frequently occurs. such as Eyelid Cancer.
Warning Signs & symptoms of Eyelid Ca (Cancer)
Basal cell carcinoma, melanoma and squamous cell ca; Initiate as precancerous sores/lesions. These precancerous scores are changes the skin that may not at first be cancerous but have a potential to develop into cancer with time.
We all know that the lighter ones complexion the more susceptible you are to sun damage, sunburn however brown & olive complexion Divas are also at risk & should apply sun screen when going out into intense sunlight; Such as a day out at the beach, picnic, amusement part or just on a regular sunny summer day.
Regretably with maturity/age our potential & susceptible to medical disorders like eyelid ca increase. Noone is immune never-the-less middle age & elders are at increased risk to develop eyelid ca & other skin cancers. For the reason every Fashionista should become a astute Pro-Self-Health Advocate & familiarize yourself to the early symptoms & signs associate with this form of cancer.
Fortunately most Eyelid Skin cancer is cureable & survivable when detected early & treated promptly.
Before I start talking I have provide you with a few definitions to medical terms you may encounter so you will be able to understand & refer back to my definitions as you read along. Unfortunately the incidence of eyelid skin cancer is on the up which may have a lot to do with our depleating ozone layers. May rub off; only to grow back!
Sores often occur on the head, neck, & hands, & elsewhere. It's difficult to know whether a particular lesion will progress over time into Ca. I recommend you do monthly skin assessment in front of a mirror to check for unusual moles & growths; just as you perform your monthly self-breast-exams. Early discovery & intervention can prevent development of squamous cell skin cancer.
Definitions & Explanations
Carcinoma = Cancer = Ca (abbreviation).
Squamous cell carcinoma = (SCC) is a form of cancer of the cancerous type that may occur in various organs, such as skin.
To understand basal and squamous cell skin cancers, it helps to know about the normal structure and function of the skin.
Normal skin
The skin is the largest organ in your body. It does several different things:
Covers the internal organs and protects them from injury
Serves as a barrier to germs such as bacteria
Prevents the loss of too much water and other fluids
Helps control body temperature
Protects the rest of the body from ultraviolet (UV) rays
Helps the body make vitamin D
The skin has 3 layers: the epidermis, the dermis, and the subcutaneous
Epidermis The top layer of skin is the epidermis. The epidermis is thin, averaging only 0.2 millimeters thick (about 1/100 of an inch). It protects the deeper layers of skin and the organs of the body from the environment.
Keratinocytes are the main cell type of the epidermis. These cells make an important protein called keratin. Keratin helps the skin protect the rest of the body.
The outermost part of the epidermis is called the stratum corneum, or horny layer. It is composed of dead keratinocytes that are continually shed as new ones form. The cells in this layer are called squamous cells because of their flat shape.
Living squamous cells are found just below the stratum corneum. These cells have moved here from the lowest part of the epidermis, the basal layer. The cells of the basal layer, called basal cells, continually divide to form new keratinocytes. These replace the older keratinocytes that wear off the skin's surface.
Cells called melanocytes are also found in the epidermis. These skin cells make the brown pigment called melanin. Melanin is what gives the skin its tan or brown color. It protects the deeper layers of the skin from some of the harmful effects of the sun. When skin is exposed to the sun, melanocytes make more of the pigment, causing the skin to tan or darken.
The epidermis is separated from the deeper layers of skin by the basement membrane. The basement membrane is an important structure because when a skin cancer becomes more advanced, it generally grows through this barrier.
Dermis
The middle layer of the skin is called the dermis. The dermis is much thicker than the epidermis. It contains hair follicles, sweat glands, blood vessels, and nerves that are held in place by a protein called collagen. Collagen, made by cells called fibroblasts, gives the skin its resilience and strength.
Subcutis
The deepest layer of the skin is called the subcutis. The subcutis and the lowest part of the dermis form a network of collagen and fat cells. The subcutis helps the body conserve heat and has a shock-absorbing effect that helps protect the body's organs from injury.
Types of skin cancer
Melanomas
Cancers that develop from melanocytes, the pigment-making cells of the skin, are called melanomas. Melanocytes can also form benign growths called moles. Melanoma and moles are discussed in our document called Melanoma Skin Cancer.
Skin cancers that are not melanoma are sometimes grouped together as non-melanoma skin cancers because they tend to act very differently from melanomas.
Keratinocyte cancers
These are by far the most common non-melanoma skin cancers. They are called keratinocyte carcinomas or keratinocyte cancers because when seen under a microscope, their cells share some features of keratinocytes, the most abundant cell type of normal skin. The most common types of keratinocyte cancer are basal cell carcinoma and squamous cell carcinoma.
Basal cell carcinoma-When seen under a microscope, these cancers share features with the cells in the lowest layer of the epidermis, called the basal cell layer.
About 8 out of 10 skin cancers are basal cell carcinomas (also called basal cell cancers). They usually develop on sun-exposed areas, especially the head and neck. Basal cell carcinoma was once found almost exclusively in middle-aged or older people. Now it is also being seen in younger people, probably because they are spending more time in the sun with their skin exposed.
Basal cell carcinoma tends to be slow growing. It is very rare for a basal cell cancer to spread to nearby lymph nodes or to distant parts of the body. But if a basal cell cancer is left untreated, it can grow into nearby areas and invade the bone or other tissues beneath the skin.
After treatment, basal cell carcinoma can recur (come back) in the same place on the skin. People who have had basal cell cancers are also more likely to get new ones elsewhere on the skin. As many as half of the people who are diagnosed with one basal cell cancer will develop a new skin cancer within 5 years.
Squamous cell carcinoma
About 2 out of 10 skin cancers are squamous cell carcinomas (also called squamous cell cancers). They commonly appear on sun-exposed areas of the body such as the face, ears, neck, lips, and backs of the hands. They can also develop in scars or skin ulcers elsewhere. They sometimes start in actinic keratoses (described below). Less often, they form in the skin of the genital area.
Squamous cell carcinomas tend to be more aggressive than basal cell cancers. They are more likely to invade fatty tissues just beneath the skin, and are more likely to spread to lymph nodes and/or distant parts of the body, although this is still uncommon.
Keratoacanthomas are growths that are found on sun-exposed skin. They may start out growing quickly, but their growth usually slows down. Many keratoacanthomas shrink or even go away on their own over time without any treatment. But some continue to grow, and a few may even spread to other parts of the body. Their growth is often hard to predict, and many skin specialists consider them a type of squamous cell skin cancer.
Less common types of skin cancer
Along with melanoma and keratinocyte cancers, there are some other much less common types of skin cancer. These cancers are also non-melanoma skin cancers, but they are quite different from keratinocyte cancers and are treated differently.
Other non-melanoma skin cancers include:
Merkel cell carcinoma
Kaposi sarcoma
Cutaneous (skin) lymphoma
Skin adnexal tumors
Various types of sarcomas
Together, these types account for less than 1% of non-melanoma skin cancers.
Merkel cell carcinoma
This uncommon type of skin cancer develops from neuroendocrine cells (hormone-making cells that resemble nerve cells in some ways) in the skin. They are most often found on the head, neck, and arms but can start anywhere.
These cancers are thought to be caused in part by sun exposure and in part by Merkel cell polyomavirus (MCV). About 8 out of 10 Merkel cell carcinomas are thought to be related to MCV infection. MCV is a common virus. Many people are infected with MCV, but it usually causes no symptoms. In a small percentage of people with this infection, changes in the virus' DNA can lead to this form of cancer.
Unlike basal cell and squamous cell carcinomas, Merkel cell carcinomas often spread to nearby lymph nodes and internal organs. They also tend to come back after treatment. Treatment of Merkel cell carcinoma is described in the section called “Treating Merkel cell carcinoma.”
Kaposi sarcoma
This cancer usually starts within the dermis but can also form in internal organs. It is related to infection with Kaposi sarcoma herpesvirus (KSHV), also known as human herpesvirus 8 (HHV8). Before the mid-1980s, this cancer was rare and found mostly in elderly people of Mediterranean descent. Kaposi sarcoma has become more common because it is more likely to develop in people with human immunodeficiency virus (HIV) infection and the acquired immunodeficiency syndrome (AIDS). It is discussed in our document called Kaposi Sarcoma.
Skin lymphomas
Lymphomas are cancers that start in lymphocytes, a type of immune system cell found throughout the body in the bone marrow (the soft inner part of some bones), lymph nodes (bean-sized collections of immune system cells), the bloodstream, and some internal organs. The skin also contains a large number of lymphocytes.
Most lymphomas start in lymph nodes or internal organs, but there are certain types of lymphoma that appear to begin mostly or entirely in the skin. Primary cutaneous lymphoma is the medical term for lymphomas that start in the skin. The most common type of primary cutaneous lymphoma is cutaneous T-cell lymphoma (most of these are called mycosis fungoides). Cutaneous lymphomas are discussed in our document called Lymphoma of the Skin.
Adnexal tumors
These tumors start in the hair follicles or glands (such as sweat glands) of the skin. Benign (non-cancerous) adnexal tumors are common, but malignant (cancerous) ones, such as sebaceous adenocarcinoma and sweat gland adenocarcinoma, are rare.
Sarcomas
Sarcomas develop from connective tissue cells, usually in tissues deep beneath the skin. Much less often they may develop in the skin's dermis and subcutis. Several types of sarcoma can develop in the skin, including dermatofibrosarcoma protuberans (DFSP) and angiosarcoma (a blood vessel cancer). Sarcomas are discussed in our document called Sarcoma – Adult Soft Tissue Cancer.
Pre-cancerous and pre-invasive skin conditions
These conditions may develop into skin cancer or may be very early stages in the development of skin cancer.
Actinic keratosis (solar keratosis)
Actinic keratosis, also known as solar keratosis, is a pre-cancerous skin condition caused by overexposure to the sun. Actinic keratoses are usually small (less than 1/4 inch across), rough spots that may be pink-red or flesh-colored. Usually they develop on the face, ears, back of the hands, and arms of middle-aged or older people with fair skin, although they can arise on other sun-exposed areas. People with one actinic keratosis usually develop many more.
Actinic keratoses are slow growing. They usually do not cause any symptoms. In some cases actinic keratoses may turn into keratinocyte cancers. They often go away on their own, but they may come back.
Even though most actinic keratoses do not become cancers, they are a warning that your skin has suffered sun damage. Some actinic keratoses and other skin conditions that could become cancers may have to be removed. Your doctor should regularly check any that are not removed for changes that could indicate cancer.
Squamous cell carcinoma in situ (Bowen disease)
Squamous cell carcinoma in situ, also called Bowen disease, is the earliest form of squamous cell skin cancer. "In situ" means that the cells of these cancers are still entirely within the epidermis and have not invaded the dermis.
Bowen disease appears as reddish patches. Compared with actinic keratoses, Bowen disease patches tend to be larger (sometimes over 1/2 inch across), redder, scalier, and sometimes crusted.
Like invasive squamous cell skin cancers, the major risk factor is overexposure to the sun. Bowen disease can also occur in the skin of the anal and genital areas. This is often related to sexually transmitted infection with human papilloma viruses (HPVs), the viruses that can also cause genital warts.
Benign skin tumors/lesions/sores include:
Seborrheic keratoses: tan, brown, or black raised spots with a waxy texture or rough surface.
Hemangiomas: benign blood vessel growths often called strawberry spots or port wine stains.
Lipomas: soft growths of benign fat cells.
Warts: rough-surfaced growths caused by a virus
Atypical moles are larger (one-quarter inch across or larger) and more irregular in shape, with notched or fading borders. They may be flat or raised or the surface smooth or rough. Often of mixed color, like; purple, brown pink, red & beige.
Keep in mind & don't panic when you see a common mole on your skin; that Atypical moles are not automatically Ca. Some may progress to Ca. Often they are found in sun exposed & even sun-protected areas.
Oculo-facial-surgeon = Also called Oculoplatic surgeons = An oculoplastic surgeon performs revisional eyelid surgery. Entropion, ectropion, ptosis, and eyelid tumors are common.
Oculoplastic surgeons are ophthalmologists (eye doctors) who have specialised in eyelid & facial plastic surgery & use to working around the eye & face. They understand the delicate anatomy and function of the eyelids and surrounding structures, they specialise in the lacrimal (tear) system, the orbit (bone cavity around the eye), adjacent periocular (around the eyes) and facial structures, forehead & cheeks.
They perform different kinds of eyelid & facial surgery from simple eyelid malpositions to complex reconstruction involving the eyelids & surrounding forehead, temporal and cheek areas. Some Asians consult Oculo-plastic-surgeon to create the so-called Western wider eye look opposed to the slant eye appearance. Oculoplastic practioners understand how eyelid surgery affects the appearance, comfort & clarity of ones vision.
They are also known as ophthalmic plastic, reconstructive surgeons and oculo-facial surgeons.
Oculoplastic surgeons assess the surface health of the eyes and function of the eyelids prior to eyelid plastic surgery, they often recognises potential problems which can involve the eye itself such as eyelid ca.
Eyelid Ca like any cancer results when body cells multiply out of control resulting in malformed cells, immature cells & forming lesions that can become ca. Heredity, carcinogens (cancer causing agents such as chemicals) & the cumulative effects of sunlight are believed to be the common causes of eyelid & general skin cancer.
Basal cell carcinoma = is the most common type of skin cancer found on or around the eyelids. More than 90% of eyelid cancers are basal cell carcinomas if left untreated results in disfigurement, skin damage, depression due to changes in appearance & less often death.
Eyelid Ca ordinarily occurs where skin is exposed to sunlight such as one's face, neck & forearm presenting as a little sore which gets better at first only to reoccur later. Bleeding & discoloration are common signs. Often eyelid ca occurs on the lower eyelid but can occur on eyebrows around the corners of the eye on the eyelid margins or in nearby aresas of the face. Often they begin as a hard lump which may be painful or tender to touch. Eyelid ca are locally invasive & tend to burrow into the flesh & can manifest itself in the form of inflammation, thhickening of the eyelids or ulcers; they seldom spread/metastasize to distant locations.
If Eyelid Cancers is suspected an biopsy may be performed with cells removed from your eye & sent to the pathologist who determines if it's malignant/cancerous and the type of cancer. After diagnosis you and your physician will discuss the best course of action in your situtation.
Treatment depends on the type of eyelid ca. It is very important for an experienced and skilled surgeon to remove this type of eye cancer to have the best chance to preserve the eye and its function. At MD Anderson, our orbital and oculoplastic surgeons have remarkable expertise in removing and reconstructing the eyelid using specialized surgical reconstructive techniques. Reconstruction of the eyelid tissue is critical to preserving vision, maintaining comfort in the eye, and restoring appearance and function of the eyelid.
Squamous cell carcinoma: This skin cancer occurs less often on the eyelid than basal cell carcinoma, but it is more aggressive. It can spread to nearby lymph nodes and other parts of the body.
The main treatment for this type of eye cancer is surgical removal. Radiation therapy or other treatments may be used in addition to surgery if a large area is affected or if the tumor cannot be fully removed.
Another method used to remove eyelid ca is Mohs' microsurgical method, which is performed by a dermatologist. This technique is microscopically managed & may offer you the best chance for complete removeal while preserving normal tissue. Afterwards reconstruction of the residual defect is typically done withing 2 days. It's particularly suited for areas as the eyelid & periocular are, where preserving healthy tissue is important for eyelid function, reconstruction and social appearance.
As with other eyelid cancers, a reconstructive eye surgeon (oculoplastic surgeon) is key to removal and reconstruction of eyelid squamous cell carcinomas. Ophthalmic surgeons often work with experienced dermatopathologists to ensure all the tumor is removed before any eyelid reconstruction. In fact you may have to wait several days after your surgery before any reconstructive surgery can be performed, so patients is essential here. You and your doctor will want to be sure that all of the tumor has been removed.
Recovery After Eyelid Surgery
Post your procedure your surgeon will provide you with a list of instructions to help in your speedy recovery which can last a few weeks. You may have bandages and/or a protective eye shield. During this time it's not uncommon to experience dryness, itching, irritation & redness in any case medicated sometimes antibiotic eyedrops are prescribed. Your doctor may okay cool compresses to soothe, reduce swelling and discoloration. Sutures are usually removed 1-2 weeks later if used (In some situtations the self-desolving sutures may be used so that you won't have the trouble of having the removed).
Problems after eyelid surgery may include:
Bleeding and/or Pus drainage (Pus indicates infection).
Infection.
Dry eyes.
Abnormal discoloration of eyelid skin.
Eyelid skin which folds abnormally in or outwards.
Inability to fully close your eye(s).
A pulled down lower lid lash line or a possible loss of vision
If you experience any of these complications, contact your doctor as soon as possible.
Will Insurance Cover Your Eyelid Surgery?
Your health insurance carrier may pay for eyelid cancer procedures but only agree to pay reconstruction cost if the eyelids are severely deformed as result of the cancer or drooping to a level that impairs vision. Vision & biopsy may be required before surgery to confirm diagnosis. If Eyelid Cancer is not confirmed any eyelid interventions may be considered cosmetic surgery which is generally not covered by insurance since it is deemed an elective surgery (meaning not medically necessary).
Of course every one heals differently & the amount of bruising & swelling varies. You can help minimize bruising, by stopping any blood thinners (such as aspirin, ibuprofen, herbal supplements and vitamins) for at least 14 days before surgery but consult your Health-care provider prior to stopping any medication. After surgery you should elevation your head on a comfortable pillow(s) avoid straining and applying a cool compress/ice mask may help your recovery. Depending on the type of procedure you've had done you may need to take 5-7 days off work & Suture removal is typically 5-7 days after surgery. As for pain consult your health-care provider about which pain medication is best for you.
© by Tiease D. Deutsch R.N. 4/18/2012
Health Consultant/Aurthor/Artist/
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