Surgical Techniques for Eyelid Skin Cancer Removal

Anesthesiologists used neuroleptic sedation for each patient with a combination of ketamine, midazolam, fentanyl and propofol. The surgeon used loupes with a 3.3X magnification and a headlight. The tumour was assessed, measured (Figure 1A), and marked with standard four millimetre surgical margins for BCC and seven millimeter surgical margins for melanoma in situ (MIS). The width of the excised area was documented. The donor tissue width was estimated and marked (Figure 1B). The donor lid was then stretched horizontally, ensuring that the secondary defect could undergo direct closure. One drop of topical anesthesia was placed in each eye and the operative site was prepared with controlled use of chlorhexidine to limit the risk of corneal toxicity. The surgeon performed subcutaneous infiltration of the tumor and donor sites using lidocaine 2% with epinephrine 1:100,000; 2 ml or less per eyelid. All tissue was handled with 0.5 mm toothed forceps to preserve its architecture and integrity.