PMC6333075_01
Right eye at presentation with the eyelids in a physiologic position. Please note the lower eyelid mass affecting the medial part of the eyelid
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A 10 x 12 mm large, pigmented, raised, firm mass with an ulcerated hemorrhagic surface was present on the lower eyelid approximately 10 mm from the medial canthus (Figure 1).
Right eye at presentation with the lower eyelid everted to show the extent of the mass at the conjunctival side of the eyelid
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This mass was bulging from the medial lower eyelid margin and extending 5 mm into the conjunctival side of the eyelid (Figure 2).
Diagram showing the surgical procedure. A, The eyelid mass before surgery. Figure B, 5 mm margins for excision outlined. C, Full-thickness excision of the eyelid mass. D, Rhomboid flap outlined. E, Undermining of the periocular skin (shaded yellow) to allow adequate movement of the flap. F, The rhomboid flap in position. It is then sutured in place
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Full-thickness skin incisions were made through the eyelid 5 mm medial, lateral and ventral to the mass with a number 15 blade (Swann Morton Ltd., Sheffield, UK) and Stevens tenotomy scissors, to achieve en-bloc excision of the tumor (Figure 3B). Ltd., Oldbury, UK) was used to apply liquid nitrogen to the margins (Figure 3C). A proximal vertical incision was then made from the ventromedial edge of the last incision to create a rhomboid-shaped skin graft (Figure 3D). The rhomboid graft was swung dorsally and laterally to fill the eyelid defect (Figure 3E). Intradermal sutures (6-0 Vicryl ; Ethicon) were used to close the skin, leaving a "Z" shaped pattern (Figure 3F).
Hematoxylin and eosin showing a poorly differentiated squamous cell carcinoma. The tumor is effacing and ulcerating the conjunctiva and deeply infiltrates the subjacent fibroconnective tissue. There is destruction of Meibomian glands and secondary lymphoplasmacytic inflammation. Scale bar 1 mm. Inset: Neoplastic cells are often dyskeratotic and acantholytic. Note bizarre mitotic figures and cell cannibalism
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Histopathology of the eyelid mass revealed an infiltrative densely cellular neoplasm of epithelial cells, consistent with a SCC (Figure 4).
Right eye 10 d postoperatively
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Re-examination was performed 10 days, 1 month, and 12 months postoperatively (Figures 5 and 6).
Right eye 1 y postoperatively
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Re-examination was performed 10 days, 1 month, and 12 months postoperatively (Figures 5 and 6).