The initial diagnosis of a skin cancer on the upper face is generally done by a dermatologist or ophthalmologist. This tissue around the eyelid, forehead, or cheek is then evaluated under a microscope to confirm the diagnosis. In the area around the eyelids, the most common skin cancer is basal cell carcinoma. There are different sub-categories of basal cell carcinoma that predict how aggressively they grow. Other skin cancers on the face include squamous cell carcinoma and melanoma. Once the initial biopsy confirms the diagnosis, the next step is to plan removing the skin cancer and reconstructing the area excised.
Mohs surgeons are specially trained dermatologists that can remove the skin cancer, check the edges, and make sure that the least amount of normal tissue to clear the tumor is removed.  In San Diego, we have excellent Mohs surgeons who perform this procedure in the office setting. The next step after one is diagnosed with a skin cancer on the face is to coordinate this Mohs procedure and the reconstruction.
- Skin cancer diagnosed around the eyelid by biopsy
- Mohs surgery by a specially trained dermatologist in San Diego
- Eyelid and periocular reconstruction by Dr. Iyengar
Our office, San Diego Eyelid Specialists, handles this coordination with the top Mohs surgeons in the region. We find a date that works well with your schedule, the dermatologist performing the Mohs procedure, and Dr. Iyengar’s busy surgical schedule. This coordination brings the best of two specialties together in providing: the lower recurrence rate of the skin cancer by having Mohs surgery done by the dermatologist, and the best functional and aesthetic result by having a well-recognized oculoplastic surgeon perform the reconstruction. Patients often want to know when they get diagnosed with a skin cancer on the face, eyelid, cheek, or forehead, how Dr. Iyengar will be closing it or how many sutures it will require. The first step is to clear the skin cancer by Mohs surgery, then Dr. Iyengar can better provide some of the reconstructive options. Sometimes a skin graft is needed to reconstruct the areas around the eyelid and sometimes a skin flap is used to close the defect left by the Mohs surgery. Dr. Iyengar handles the most complicated eyelid reconstructions in the region providing reassurance that the functional and aesthetic result in the periocular area will be optimal. The educated patient does their homework and makes sure that the reconstruction is performed an expert in the area, an oculoplastic surgeon, and not just a plastic surgeon that likes working on eyelids. At our practice, we believe there is no substitute for having the most appropriate training and years of experience. We are often asked to fix botched eyelid reconstructions in the San Diego area. Nearly always this is due to initial reconstruction by a plastic surgeon who was not an oculoplastic surgeon in the American Society of Ophthalmic Plastic and Reconstructive Surgery (www.asoprs.org).
