Basal Cell Carcinoma on the Eyelid: Treatment Options and Concerns

Regarding skin cancer of the eyelid (basal cell carcinoma)?

Hello Dr.
Chen, I would like to consult you regarding a skin cancer issue.
My mother had a small growth on her eyelid a week before the Lunar New Year, so she went to the ophthalmology department at Hsinchu Cathay Hospital for excision and a biopsy.
A week after the New Year, the ophthalmologist called to inform her that the report showed a problem: it was a basal cell carcinoma.
She then returned to Hsinchu Cathay Hospital for a follow-up, where the doctor mentioned that since the exact location is now uncertain, it is recommended to go to Taipei Cathay for a bone scan and to consult a hematology-oncology specialist.
The nuclear medicine report from Taipei Cathay came back normal, and the hematology-oncology doctor suggested waiting for the eyelid growth to reappear before performing another surgery.
We were advised to return to Hsinchu Cathay, but since the excision after the New Year, there has been no change in the growth.
Although basal cell carcinoma rarely metastasizes, it has been several months, and we are left waiting for it to grow back.
Is there really no other treatment option available? We are concerned about the possibility of metastasis and would greatly appreciate your guidance on any alternative treatment methods or approaches.
I look forward to your response.
Thank you!

Yi Xin, 20~29 year old female. Ask Date: 2008/05/06

Dr. Chen Sirong reply Oncology

Hello Yi-Hsin, congratulations to you and also to your mother.
Basal cell carcinoma rarely metastasizes, and when excised cleanly, it seldom recurs.
I suspect the ophthalmologist has successfully removed the tumor.
Of course, the ophthalmologist may not have excised a large area, so there may not have been sufficient margins, such as a 1 cm safety margin around the tumor during excision.
In this context, to remove a tumor with a diameter of 3 cm, the excision would need to encompass a circle of that size.
While the ophthalmologist may not have removed enough tissue, it is not always necessary to excise adjacent normal tissue for basal cell carcinoma; removing the tumor itself is often sufficient.
Even dermatologists typically do not perform extensive surgeries for basal cell carcinoma to maintain cosmetic appearance.
It is advisable to monitor it with a calm mindset without any immediate treatment, as any recurrence would likely occur several years later.
At that time, it can be addressed surgically.
Very few people die from basal cell carcinoma.
Wishing you good health, thank you.

Reply Date: 2008/05/06

More Info

Basal cell carcinoma (BCC) is the most common type of skin cancer, particularly affecting areas of the skin that are frequently exposed to the sun, such as the eyelids. While BCC is generally considered to be a low-grade malignancy with a low risk of metastasis, it can still pose significant concerns, especially when located on the eyelids due to the potential impact on vision and cosmetic appearance.

In your mother's case, the initial excision of the eyelid lesion followed by a diagnosis of basal cell carcinoma raises several important considerations regarding treatment options and follow-up care. The fact that the tumor was not completely excised during the initial surgery is a common issue with BCC, particularly in delicate areas like the eyelids where preserving function and appearance is crucial.

Treatment Options
1. Observation: Given that BCCs are slow-growing and rarely metastasize, some physicians may recommend a watchful waiting approach, especially if the tumor is not currently causing any symptoms. However, this approach can lead to anxiety for patients and their families, as it involves waiting for the tumor to grow larger before further intervention.

2. Surgical Excision: If the tumor becomes more prominent or if there are concerns about its growth, surgical excision remains the gold standard for treatment. This involves removing the tumor along with a margin of healthy tissue to ensure complete removal. In cases where the initial excision was incomplete, a second surgery may be warranted.

3. Mohs Micrographic Surgery: This specialized surgical technique is particularly effective for BCCs located on the face, including the eyelids. Mohs surgery involves the step-by-step removal of the tumor and immediate microscopic examination of the excised tissue to ensure clear margins. This method minimizes the amount of healthy tissue removed while ensuring complete tumor removal.

4. Topical Treatments: For superficial BCCs, topical chemotherapy agents such as imiquimod or 5-fluorouracil may be used. These treatments can be effective for certain types of BCCs, but they are generally less effective for invasive tumors.

5. Radiation Therapy: While not typically the first line of treatment for BCC, radiation therapy may be considered in cases where surgery is not feasible due to the patient's health or the tumor's location. However, this option is usually reserved for patients who cannot undergo surgery.

Concerns About Waiting
Your concern about waiting for the lesion to grow before further intervention is understandable. While BCCs are less likely to metastasize, they can invade surrounding tissues and cause local destruction, particularly in sensitive areas like the eyelids. If the lesion is not growing or causing symptoms, monitoring may be acceptable, but it is essential to have regular follow-ups with a dermatologist or oncologist who specializes in skin cancers.

Follow-Up and Monitoring
Regular follow-up appointments are crucial for monitoring the lesion and assessing any changes. If the lesion begins to grow or change in appearance, prompt action should be taken. Additionally, educating your mother about the signs of potential complications or changes in the lesion can empower her to seek timely medical advice.

Conclusion
In summary, while basal cell carcinoma on the eyelid is generally not life-threatening, it requires careful management to prevent local complications and preserve eyelid function and appearance. Surgical options, particularly Mohs micrographic surgery, are highly effective for complete removal. If waiting is the chosen approach, ensure that there is a clear plan for monitoring and follow-up. Open communication with healthcare providers is essential to address any concerns and to make informed decisions about treatment options.

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