Eyelid Lesions & Skin Cancer

Eyelid lesions are abnormal growths or changes on the eyelid that may be benign or cancerous. Early evaluation and appropriate treatment can help protect the eye and prevent the spread of skin cancer.

Reconstructive & Functional

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Chalazion

Chalazion ( plural= chalazia) or commonly called a “stye” is a common, benign, non-infectious inflammation of the eyelid that occurs when the major oil (lipid) producing gland of the eyelid (meibomian gland) is obstructed, preventing its normal secretion onto the surface of the eye (see diagram below). The obstruction may occur from an underlying inflammation and debris accumulation along the eyelid margin, termed blepharitis. Blepharitis is often associated with the dermatologic condition termed rosacea (reddening of the skin and fine vessels seen on the face). The chalazion most commonly presents as a single reddish nodule near the lid margin, though multiple lesions may occur. Fortunately, most lesions respond well to a conservative course of warm compresses to the eyelid and attentive eyelid hygiene. In the event that the chalazion does not resolve with this conservative treatment steroid injection or, more commonly, surgical incision and drainage is performed in the office surgical suite. Prior to the procedure it is critical to apply warm compresses for a couple of days, as the heat tends to help liquefy the congealed wax-like fatty secretions of the eyelid facilitating its surgical drainage. The doctor will examine you closely to see if there are any atypical features of the chalazion that may warrant biopsy.

Left: Chalazion of right upper lid and left lower lid. Right: Close-up view of right upper lid with “pointing” of the chalazion at the eyelid gland (Meibomian) opening.

Left: Schematic of chalazion. Cross-sectional view of an upper lid (front is to the left): A) Obstruction of eyelid meibomian glands B) Fatty contents of eyelid glands expanding into soft tissue of eyelid C) Surrounding redness of eyelid secondary to inflammation. Right: Clinical appearance of a typical chalazion.

Multiple Chalazia of upper and lower lids

Benign Eyelid Lesions

There are numerous benign growths that can afflict the eyelid region. If bothersome, suspicious, or demonstrate increasing growth they can be removed. Great care needs to be taken to maintain the anatomic integrity of the smooth contour of the lid margin, eyelashes, and the tear drainage system (punctum and canaliculi) when performing surgery in this delicate area.

Cysts

Clear cyst at the left lower eyelid margin adjacent to the tear drain opening (punctum)

Cyst at outer corner of eyelid

Nevus

(plural = NEVI)- are benign, typically pigmented, lesions.

Small nevus located adjacent to the punctum.

Left: Compound ( elevated) nevus located with the brow hairs Right: Following surgical excision and repair, note minimal disruption to the brow hairs.

Large nevus involving the upper and lower lids. This lesion was formed in utero, early in gestation while the upper and lower lids are connected. The lids later divide, and the eye opens, forming upper and lower lids. This connected nevus between the upper and lower lids is termed a “kissing” nevus.

Xanthelasma

Are yellowish, fat deposits with sharp borders that are typically located in the inner corners of the eyelids. These lesions may be associated with markedly elevated blood cholesterol. If bothersome, they can be removed.

Skin Cancers

Due to a lifetime of sun exposure, skin cancers are commonly found in the eyelid region. Basal cell carcinoma is, by far, the most common skin cancer, followed by squamous cell carcinoma, then much more rarely melanoma or sebaceous cell carcinoma, which though extremely rare has a propensity to occur in the eyelid region.

Symptoms: Presentation of these eyelid cancers can be subtle, including a small non-resolving bump mimicking a chalazion, a localized area of loss of lashes, a small notch within the lid margin, or localized area of skin breakdown with chronic bleeding or discharge.

Diagnosis: Careful examination and biopsy of suspicious lesions confirms the diagnosis of skin cancer.

Treatment (Excision / Reconstruction):

Excision of skin cancer
Complete surgical excision and reconstruction of the resultant defect is the best way to treat skin cancers. Depending upon the type ( and subtype) of skin cancer, it’s clinical appearance, location, and whether or not it is a recurrent tumor will determine the recommended method of tumor removal. The goal of eyelid tumor removal is straightforward: complete removal of the tumor while sparing normal surrounding tissue. The eyelid real estate is quite limited and valuable, so it is very desirable to preserve as much normal tissue as possible to facilitate the reconstruction of the tumor defect. Thus, in select cases, Mohs’ micrographic surgery is advised. Mohs’ surgery is performed by a specially-trained dermatologic surgeon who removes the tumor precisely in stages to insure the complete removal of the entire skin cancer ( to prevent recurrence) and maximal preservation of surrounding tissues to facilitate repair. Dr. Rubin performs reconstructive surgery

Reconstruction:
Reconstruction of the defect is directed at two aligned goals: 1) Maintenance of the position and function of the eyelids ( to protect the eye) and 2) Creating the best cosmetic outcome. Based upon the patient’s underlying anatomy and the extent of the tumor defect, Dr. Rubin customizes the reconstruction in every case. In straight forward repairs the local tissues can be directly closed. However in more complex cases a wide range of potential reconstructive techniques may be used, including: rearrangement of local tissue ( “flaps”) or skin grafts harvested to match the delicate eyelid skin.

Basal Cell Carcinoma Right Lower Lid, 22 year-old Male

Basal cell carcinoma of right lower lid pre-op ( left), following Mohs excision of tumor with resultant 60% defect of lower eyelid; first stage repair included a flap from the upper to lower lid to restore the mucous membrane ( conjunctiva ) and soft tissue support ( tarsus) of the back side of the eyelid. The front portion of the lid was repaired with skin and muscle flap from the lower lid. After division of the flap 4 weeks after surgery, the lower lid’s function and appearance was restored.

Basal Cell Carcinoma, 94 year-old Female

Left: Pre-operative appearance with a basal in the upper eyelid and a coincidental outward turning of the lower lid ( ectropion). Center: Appearance after Mohs excision of skin cancer. Right: Post-op appearance after closure of the upper lid defect and repair of the ectropion of the lower lid.

Basal Cell Carcinoma , 57 year-old male

Left: Large, neglected basal cell carcinoma of the outer corner of the left eye
Center: Following Mohs excision of tumor. Defect was closed with a rotational flap from the cheek.
Right: Post-operative appearance

Basal cell carcinoma right lower lid, 72 year-old male

Left: Pre-operative appearance
Center: Following Mohs excision of tumor
Right: Post operative appearance

Because Every Patient Deserves Exceptional Care.

The finest results are noticed not because you look different, but because you look naturally refreshed.

— Peter A.D. Rubin, M.D.

Google Rating

4.7/5 (75+ Reviews)

    
 
 
         
   Lenore Cooper-Clarke 
 
 
 
 Trustindex verifies that the original source of the review is Google. I am extremely pleased with the results of my upper eyelid surgery. The before and after results are natural and noticeable. The improvement is significant. Dr. Peter Rubin is professional, skilled and attentive. I highly recommend him.
  
 
        
   Pam O'Leary 
 
 
 
 Trustindex verifies that the original source of the review is Google. Dr. Rubin repaired my eyelid and did a fantastic job, it’s perfect. The staff is friendly, attentive and very helpful. I highly recommend Dr. Rubin!
  
 
        
   Rosanne Smith 
 
 
 
 Trustindex verifies that the original source of the review is Google. Consult visit  Very pleased with Dr Rubin’s thoroughness and professionalism  Staff is responsive and personable  I definitely would recommend his practice and will be seeking his services in the future
  
 
        
   Cyndi Moeller 
 
 
 
 Trustindex verifies that the original source of the review is Google. I had an excellent experience with Dr Rubin repairing my clogged tear duct. I had difficulty finding a Dr in this area who performed this type of surgery but Dr Rubin was worth the wait. The surgery was a success, and my recovery has gone smoothly thanks to the outstanding care I received. I truly appreciate the skill, attention to detail, and concern shown by both the doctor and his staff.                                          I highly recommend this practice to anyone looking for exceptional eye care.
  
 
        
   Julie Hayek 
 
 
 
 Trustindex verifies that the original source of the review is Google. I highly recommend Dr Rubin. He is the best ocular surgeon in Florida.  His attention to detail and talent as a surgeon is unparalleled.  He also cares about his patients and takes the necessary time to explain procedures and answer questions. I have been his patient for about five years and travel 30 minutes to see him.  I am so happy my doctor referred him to me.
  
 
        
   Ashleigh Rogers 
 
 
 
 Trustindex verifies that the original source of the review is Google. I had my tear ducts plugged 20 years ago and over time, one became fully blocked and infected. I had lived with a lump in my eyelid for the last two years. Dr. Rubin performed a 30 minutes procedure, removed all the plugs and the next day, my eyelid looks normal again! While some irritation was expected, it’s so minor. I’m so thrilled to have finally done this.
  
 
        
   Gary Budjinski 
 
 
 
 Trustindex verifies that the original source of the review is Google. All of my life I had drooping eyelids. Old age set in and my vision was becoming dimmed. My eyelid muscles keep weakening. Dr. Rubin gave me vision that I have never had before in my life at 78
  
 
        
   Cynthia Green 
 
 
 
 Trustindex verifies that the original source of the review is Google. Thanks to Dr rubin and staff i can see better out of my right eye. The cloud that was hanging over it has been removed.  Thank you Dr rubin you are a God sent
  
 
        
   Deb Duffy 
 
 
 
 Trustindex verifies that the original source of the review is Google. Dr. Rubin did an amazing job fixing my eyelids. I have had a droopy eyelid for years and finally decided to get it fixed so I could see better and have it look better. He also did the other eye that appeared to be heading in that same direction. Dr. Rubin was wonderful to work with as was everyone in his office. I really appreciate his expertise and am very happy with the results. I highly recommend Dr. Rubin and his office staff for anything eye surgery related. Please see the before and after below.
  
 
        
   Deb N. 
 
 
 
 Trustindex verifies that the original source of the review is Google. Dr. Rubin was referred to me by three different people, my regular eye doctor in Hobe Sound, a friend who went to him for a procedure and also from a plastic surgeon in West Palm Beach… all three highly recommended him. I saw Dr. Rubin to have a chalazia removed from my eye lid. He also suggested that l think about having dry eye treatments, but that insurance does not cover the treatments.  I have been undergoing the treatments since December, (they are almost finished. ) My dry eye syndrome feels like it is gone . I no longer wake up with burry  eyesight reaching for eye drops.  The treatments have made a huge difference! Dr. Rubin and his staff are fantastic. Office visits are a pleasure, the office environment is friendly, knowledgeable and supportive . I highly recommend this practice.