Surgery for melanoma after cosmetic eyelid surgery

By Joseph Walrath, MD | Mar 10, 2014 | Cosmetic, Reconstruction, Tumor

Often, I perform cosmetic surgery at the same time as reconstructive surgery, and the story often involves a patient who has upper lids obscuring his or her vision, but who also wants to have an improvement in lower lid appearance.  Occasionally, the circumstances are less optimal.

E.C. came to me for a complaint of upper lids that were heavy, and I performed an open hairline brow lift and upper blepharoplasty.  She had numerous freckles, which we did not think much of.  However, several weeks into the postoperative period, she noticed that the pigmented area was increasing in size in the left lower lid.  We decided to perform a biopsy at that point, and the result was discouraging: melanoma.

She underwent a “slow-Mohs” surgical procedure by a dermatologist: to make a long story short, it is more time-consuming than other types of skin cancers and involves resection, following by tissue fixation overnight, followed by another round of office resection of tumor if the margins remain positive.  This process can take a week, and can be draining for patients, to say the least.

At the end of the day, she lost her entire left lower lid.  This is a bitter pill to swallow, especially after having had a significant cosmetic procedure in the preceding months that led to a very favorable result.

The reconstruction involved reconstructing the eyelid layer by layer, using tissue from the upper lid, combined with a skin graft.  The procedures went well.  The healing process from procedures such as these takes months.  She has done exceedingly well overall and has an excellent appearance, and is disease free, and happy.


Her own summary of the experience is included below:

Dear Dr.Walrath,                                                               March 7, 2014
How do you say “thank you” to someone who has changed your whole life?  It isn’t an easy thing to do.  When I first met you I was impressed by your professional, knowledgeable, yet warm and friendly manner.  I thought I am comfortable with this doctor operating on me.  My blepharoplasty operation went even better than I expected and when I saw you the following week I was looking forward to getting my stitches out and the completion of my healing.  I had asked you to remove a couple of spots beneath my left lower lid, and after an earlier trip to the dermatologist you recommended, I was pleased to find you had done the biopsies of the area.  I remember you telling me at that post operative visit that I was healing well and that you were pleased with my progress.  Then the words no patient wants to hear, “you have melanoma”.  I never expected that.  While it was a shock, I never realized at that time what a difference it would make in my life.
From that point on my journey with you became more difficult, but you were always there reassuring me and giving me hope and confidence.  To be honest, I don’t know how I would have made it through without your skill, dedication, and caring. 
The six excisions I had with the dermatologist left me emotionally drained, frightened, depressed, and fragile, which was a new experience for me since I am normally an upbeat, confident, happy person.  When I looked in the mirror I didn’t want to know the person I saw staring back at me.  I felt sure that small children would run in the other direction, and adults would turn their heads and look the other way when they saw me.  It was a very bleak time, and even though you told me you could repair the damage, I just couldn’t quite convince myself that it was true.
The next operation to “put me back together” went without a hitch, and it was your calm assurance and confidence I remember just before I surrendered to the effects of the drugs.  When I woke up and began to recover, it was my trust in you that allowed me to begin my journey back from the dark place where I had gone.
Later, when you opened up my eye again I began to hope that I might once more have a normal life.  While I still didn’t look great, since I was just beginning to heal, I could see the possibility.  Then I had a problem with scar tissue under my upper eyelid and was told to come into the surgery center where you were operating that day.  I knew that you had most likely gotten there very early in the morning and been operating all day.  It was close to 5 P.M. and I’m sure you were looking forward to going home to enjoy a well deserved weekend with your family.  I believe many doctors would have just said “I’ll see you on Monday”, but not you.  You put aside your own personal desires and needs and took the time to make sure you helped me through a very painful situation.  Once again you showed yourself to be an extremely gifted surgeon, and you exemplify the very best in medicine – a caring physician who strives to make certain their patient has the best care possible.
Now, as I look back on the journey we’ve taken together, I wonder if there ever might be a way I could express my thanks to you for giving me back my life.  I never knew when I heard the word melanoma what a change that would bring about.  I am so grateful that now, because of you, I HAVE A LIFE.  Without that first surgery, I might not.  Without your skill I might never again have looked into a mirror and seen the face and person I have always known.  Without your compassion I might have become permanently scarred emotionally.  It was you who gave me courage.  It was your warm smile that made my heart lighter and the worst day a little brighter.  It was you and the unique doctor that you are, that made it possible for me to look back on this time with gratitude. 
I wish there was more I could say than just “thank you”.  They are such small words for such an immense gift.  How do you thank someone for giving you back your life?  I don’t know, but I hope you will understand how grateful I am and how blessed I feel for having been fortunate enough to have you as my doctor.  Again, Dr. Walrath, my most sincere and heartfelt thanks.