At Home with Dr Christian Jessen - 135

PROMOTION

EXPERT
EYECARE
GUIDE

MEET THE
EXPERT

Miss Julia Sen
is an oculoplastic
surgeon at the
Worcestershire
Acute NHS Trust
She has a specialist interest in
periocular skin cancers including
the Mohs technique and eyelid
reconstructive surgery. She is involved
in undergraduate and postgraduate
teaching and has presented her
research at international meetings
and in peer-reviewed journals.

The head and neck
are common areas
for skin cancer as they're
exposed to sunlight
Left lower lid basal
cell carcinoma

Following Mohs
microsurgical excision

SUSCEPTIBLE AREAS

Growth, usually over a period of months, is a
key feature of skin cancer. Eventually the lesion
may begin to crust or bleed following minor
trauma. Melanoma may arise from an existing
mole or as a new lesion; sinister signs include
appearance of a pigmented area or darkening
and growth of an existing mole. The skin
surrounding the lesion may also start to
appear reddened and inﬂamed. Patients who
experience these symptoms are strongly advised
to see their GP for referral to a specialist.
The head and neck are particularly
susceptible to skin cancer because they
are sun-exposed areas. Tumours involving the
eyelids are considered particularly high risk
because of their ability to grow into the eye
socket, which in the worst case scenario may
lead to loss of the eye. There is also a higher
risk of recurrence in the periocular area;
recurrences are more difﬁcult to cure by
conventional surgery than primary tumours
and may also behave more aggressively.

TUMOUR TARGET

The British Association of Dermatologists
recommends surgical excision as the treatment
of choice for both melanoma and NMSC. The

Post-operative result after
reconstructive surgery

tumour is removed with a margin of normal
-looking tissue around it (since cancerous cells
extend beyond the visible tumour) and the area
is then reconstructed by mobilising healthy
adjacent tissues into the area of excision.
Mohs micrographic surgery is a technique
developed in the US for the treatment of certain
types of NMSC. Now practiced in specialist
centres worldwide, it offers the highest chance
of complete cure for both new and recurrent
basal cell carcinoma (the commonest type of
NMSC). Mohs surgery is also superior to
conventional excision in terms of conserving
normal tissue, thereby reducing the loss of
vital structures. The British Association of
Dermatologists (BAD) recommends Mohs
micrographic surgery as the treatment of choice
for recurrent basal cell carcinoma (BCC) and
for the most aggressive type of BCC in the
eyelid area, because of the higher cure rate
associated with the use of this technique.
The repair of the wound created by removal
of a skin cancer requires reconstructive surgery.
Certain challenging areas, such as the eyelids,
usually require the skills of a specialist
oculoplastic surgeon or an ophthalmologist
(eye surgeon) who has undertaken speciﬁc
training in eyelid and lacrimal (tear drainage)

surgery. The eyelids have a vital function in
protecting the eye and facilitating sight through
distribution and drainage of the tear ﬁlm.
The reconstructive repair must be undertaken
in a way that restores these functions and
also results in a cosmetically optimal outcome.
In some patients removal of the tumour may
have resulted in damage to the tear drainage
system, leaving the patient with a watering eye.
The oculoplastic surgeon can offer such patients
further surgery to address this once the
wounds from the tumour surgery have healed.
The management of skin cancer in the
UK is now undertaken within regional
Multidisciplinary Teams (MDTs). These
teams comprise dermatologists, oncologists,
pathologists, reconstructive surgeons and
cancer nurses. This ensures that patients
receive the highest standards of care provided
by the most appropriate specialists both in
the NHS and private sectors. All specialists
who treat skin cancers are required to report
cases through their local MDT.

REDUCE YOUR RISK

Skin cancer is a common but usually curable
condition. The major risk factor is UV light;
therefore limitation of sunlight exposure and the
avoidance of sunburn and of sunbeds is highly
recommended to reduce the risks of both
melanoma and NMSC. Where a skin cancer
develops, diagnosis and treatment at an early
stage offers the best chance of complete cure.

FOR MORE INFORMATION
Call Spire Eye Centre, Southbank Hospital
on 01905 362033 or
Optegra Birmingham Eye Hospital
on 0808 149 2666.
At Home with Dr Christian Jessen

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