This woman saw me because of slight decrease in her vision. She had early cataracts in both eyes which did not need early intervention. But what grape my attention was a lesion in her lower eyelid which had a black centre.
An ulcerated, pigmented lesion in the right lower lid.
On further questioning, she mentioned the lesion appeared 6 months earlier and had got progressively bigger and sometime bled which she scrated it accidentally. The history and the appearance were suggestive of basal cell carcinoma. I advised her to have the lesion excised to avoid it getting bigger. However, she was reluctant to have any surgery done to her face because of fear of getting an unsightly scar. I showed her some of my patients who had ignored the lesion only to need multilating surgery later when the condition was in an advanced stage.
An old man who ignored a right lower lid basal cell
carcinoma until it destroyed the lower lid and the eye.
The orbital content, lower eyelid, some bones and adjacent tissues
were removed in a procedure called orbital exenternation.
Sometimes a shock tactics was needed to convey the wisdom of having a facial cancer removed early. She agreed to the surgery and the lesion was removed with 3mm of clear margin. After ascertaining the margin is clear of the tumour, the defect was closed with a skin flap.
Steps in excision of the tumour and reconstruction.
Appearance at 2 weeks after surgery.
Appearance at 4 weeks after surgery.