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Choose your malignant eyelid lesion removal option based on your lesion observations
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WAIKOLOA, Hawaii — At the Hawaiian Eye meeting here, Wendy W. Lee, MD, discussed three options for the removal of malignant eyelid lesions.
“It’s important for you to formulate an idea in your mind when you see these eyelid lesions. Does it look benign or does it look malignant? That’s your first goal, Lee said during the Oculoplastics Symposium: Principles of Functional Eyelid Surgery.
Wendy W. Lee
Malignant lesions will have loss of lashes, nodularity, telangiectasia and loss of normal skin architecture, she said.
The options that Lee recommends for skin cancer removal are surgical excision with permanent section, surgical excision with frozen section and Mohs micrographic surgery.
The advantages of surgical excision with permanent section are that it does provide the best quality of specimen for examination and it involves less time, she said.
“If the pathologist happens to find more cancer cells, then you have to bring the patient back and do a second procedure, but if you get it all out during that one procedure, it’s a one-step procedure,” Lee said.
The advantages of surgical excision with frozen section are that cure rates can be high with excellent technical processing of frozen sections and the surgical excision ensures that the lesion being removed is the intended tissue, she said. Although the surgical excision with frozen section is one procedure, it can be expensive and lengthy.
The advantages of Mohs micrographic surgery are that the same physician performs both the excision and the reading of the pathology, she said, noting that the procedure has high cure rates. Mohs does require a specially trained dermatologist .
“I use Mohs... I take out a little pizza wedge. I want to get part of what looks like the malignancy out and a part of normal tissue. I make sure I tell my patients that I’m not aiming to get the whole thing out. I just want tissue diagnosis and once we confirm that it is malignant, then the patient will go and get it done by a Mohs surgeon,” Lee said. – by Nhu Te
Reference:
Lee W. Bumps: Diagnosis and management of eyelid lesions. Presented at: Hawaiian Eye 2016; Jan. 16, 2016; Waikoloa, Hawaii.
Disclosure: Lee reports she has financial interests with Allergan, Merz Aesthetics, Galderma, Elizabeth Arden, Bausch + Lomb and Ophthalmology Web.