Apart from pentagonal wedge excision, is there any other method to deal with eyelid lesion? (photo)

Question

I’m a 26-year-old male, with an eyelid lesion on my right-eye lower eyelid. The lesion’s length is around 3mm. A plastic surgeon suggested to me that I should do a pentagonal wedge excision (width: around 5mm; vertical length: around 1 cm). I am afraid that after the surgery, the almond shape of my eye would be severely affected, making my eye look weird. May I ask, apart from pentagonal wedge excision, is there any other method that can cut out the lesion without damaging the shape of my eye?

Howard Webster, MBBS (Hons), FRACS · Answer

Hi there,The key thing in treatment for you here is understanding the pathology of the lesion. To me it looks like a benign eyelid cyst. These are common and harmless. However, if it is thought to be a type of cancer - and some eyelid rim cancers are aggressive - then a completely different and much more aggressive treatment would be needed.So:  Number 1:  It should have a tiny biopsy done if there is concern about it possibly being a cancer. This will answer the question and not leave a scar. Once the pathology is understood:2. If is is benign - personally I treat these in the office under local anaesthesia by just by scraping them off with a dermatologic curette. This method usually fixes them without a significant scar, and sometimes virtually no scar. It does not remove the lash follicles, so the lashes will regrow. It' s a very simple treatment. It leaves the area raw for a week or two, until it heals, but it is akin to the healing of a superficial abrasion.3. If it is an eyelid margin cancer - then a wide excision will be needed and that will leave a vertical scar on your lower eyelid, as you describe the proposed treatment plan you've been given.Hope this helps, CheersHoward WebsterPlastic Surgeon.

Ivan Vrcek, MD, FACS · Answer

Thank you for your photo and question.
In my opinion, pentagonal wedge is the way to go. In my experience, simply shaving lesions like this off flush with the eyelid margin results in recurrence weeks to months after removal. 
While you are correct, pentagonal wedge sounds scary, be reassured that in most cases the shape of the eye does not change drastically. There is some laxity in the eyelid itself and in the lateral canthal tendon that supports the eyelid.
I certainly recommend an ASOPRS-trained oculoplastic surgeon for this time of surgery.
Best of luck!

Sara A. Kaltreider, MD (retired) · Answer

Pentagonal wedge excision is a good option. Another option is shaving the lesion flush with the lid margin. If the lesion is shaved, then there is a possibility that it could return, or that the eyelash follicles could be harmed with cautery. If there are any healing issues, notching, loss of lashes - then the pentagonal wedge could be done as a secondary procedure if needed. Best wishes with your decision.

Apart from pentagonal wedge excision, is there any other method to deal with eyelid lesion? (photo)

Answers (3)

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