Total Excision of the Upper Eyelid in a Patient with Sebaceous Cell Carcinoma

This 72 year-old woman from a remote village developed a rapidly growing lesion of the right upper eyelid. Examination showed the whole upper eyelid was invaded by the tumour. Biopsy revealed sebaceous cell carcinoma. This type of cancer is more common in Asians than other races and is not related to sun exposure like basal cell carcinoma or squamous cell carcinoma. I excised the whole upper eyelids and replaced it with the lower eyelid using a technique called Cutler-Beard's flap in August last year. 

A rapidly growing mass in the right upper lid 

destroying most of the eyelashes. 

The mass involved nearly all the upper eyelid and biopsy 

showed this to be sebaceous cell carcinoma. 

Steps of upper eyelid reconstruction in this patient. a-c. The upper eyelid

 was excised with normal looking tissue to ensure the margin is free 

of tumour. d-g. Full thickness lower eyelid was used to cover

 the defect. This was done in 3 layers: conjunctiva of lower lid 

to conjunctiva of upper lid; orbicularis muscle of lower lid 

to levator of the of the upper and skin to skin. 

h. End of the procedure. 

Appearance of the eye at one week post-operative. The patient was

discharged and given date for opening the flap in 2-month time. 

For various reasons the patient was unable to return for secondary surgery until February this year (6 months after the primary procedure). After opening the flap, she was able to move her eyelid normally and there was no recurrence of the tumour. 

a. Appearance of the right eyelid 6 months after the Cutler-Beard's procedure.

b, c, and d. Opening up of the flap. e. right eyelid at 3-week after lid opening.