Basal cell carcinoma reconstruction – optimizing cosmetic results

By Joseph Walrath, MD | Oct 6, 2014 | Eyelid Malposition, Reconstruction

Basal cell carcinoma is quite common, especially on the face, since it is associated with sun exposure. Around the eyelids, it is most commonly found on the lower lids (which have more direct sunlight exposure).  Of all the different types of skin cancers, it is the most common in Western countries.

The standard of care for these lesions generally involves working with a specially trained dermatologist who removes the tumor using the Mohs technique — this technique removes all of the tumor and leaves as much of the surrounding “normal” tissue behind as possible.  After the tumor has been removed, an oculoplastic surgeon can proceed with the reconstruction.

Depending on the location, there are usually several different options for reconstruction.  The reconstructive method is determined based on the extent and location of the tumor, taking care to optimize placement of incisions while maintaining normal lid function. The patient depicted below is seen after the dermatologist removed a (fortunately) relatively superficial basal cell carcinoma.


Note that the outer part of the lower lid has already been reconstructed from a prior basal cell carcinoma.  There are no lashes in that region, since that part of the lid was removed by a Mohs dermatologist in the past.

The same patient is depicted below, immediately after Dr. Walrath’s reconstruction.


The final pictures are after 8 months, demonstrating the final result.