Outcomes after surgical resection of lower eyelid tumors and reconstruction using a septal chondromucosal graft and an upper eyelid skin flap

Abstract

PurposeSurgical excision of large malignant lower eyelid tumors may cause important full‐thickness eyelid defects. The reconstruction of such defects must reestablish an acceptable aesthetic result and also restore the physiologic function of the eyelid.MethodsWe report the outcomes of full‐thickness excision of tumors extending over half of the horizontal lid length, followed by reconstruction using a septal chondromucosal graft (coming from the ipsilateral nasal cavity) and an upper eyelid skin flap. Histological analysis of the specimen identified the tumor type and surgical margins for each patient.Results25 patients were operated with this technique between March 2009 and June 2015: 17 basal cell carcinomas, 3 spindle cell carcinomas and 5 conjunctival melanomas (out of which 2 were associated with lentigo malignant melanoma). Mean duration of follow‐up after surgery was respectively 36, 41 and 17 months for each of these 3 tumor types. We found a single local tumor recurrence and it was a basal cell carcinoma in a xeroderma pigmentosum patient. We describe some of the possible surgical complications and functional sequelae.ConclusionsIn the case of eyelid tumors, the need to perform complete oncologic excision with margins adapted to tumor type may result in the removal of an important part of the eyelid. Several surgical techniques are available for lower eyelid reconstruction; the choice of the technique and its results depend mainly on the surgeon's experience.In malignant tumors, complete surgical excision with margins adapted to tumor type prevents local recurrence in most cases. Our repair strategy gives good aesthetic and functional results.