LUMPS AND BUMPS

Eyelid/facial lumps and bumps (lesions) are common in patients referred to oculoplastic surgeons. Many lesions can be readily diagnosed on the basis of their clinical examination characteristics alone e.g. a chalazion (or meibomian cyst).

A typical upper lid chalazion		A typical benign intradermal naevus

Xanthelasmata (yellow fat deposits in the inner aspect of the eyelid skin)

A number of other lesions can be readily diagnosed by clinical examination alone. The main goal in the evaluation of these lesions is to differentiate malignant from benign lesions. In general, the majority of malignant tumours affecting the eyelids and periocular area are slowly enlarging, destructive lesions that distort or frankly destroy eyelid anatomy. There are a number of subtle features that can help to differentiate malignant from benign eyelid tumours. Some malignant lesions, however, may appear innocuous. Conversely some benign lesions may appear sinister. For this reason it can be extremely difficult to make the correct diagnosis of an eyelid lesion without a biopsy.

For small lesions an excisional biopsy (the whole lesion is removed) serves two functions: diagnosis and treatment. For larger lesions an incisional biopsy (only a small piece of the lesion is removed) is undertaken for diagnostic purposes. The lesion is then treated appropriately on the basis of the histopathology report.

A lower lid rodent ulcer (basal cell carcinoma or BCC) mimicking blepharitis

What happens before surgery?

You will visit the clinic a few days or weeks before the date of your surgery to have a preoperative consultation with your surgeon. In addition to examining the lesion(s) he/she will ask you questions about your current and past health, and will need to know about any allergies you may have, medications you are taking (including over the counter products e.g. aspirin, indomethacin and whether you smoke.

The surgery is usually performed under local anaesthesia (a tiny needle is inserted in the skin around the lesion and local anaesthetic is injected). For patients who are anxious a light sedative can be given intravenously by an anaesthetist. This acts very quickly but also wears off very quickly after the surgery. For patients who are very anxious about surgery around their eyes a very short general anaesthetic can be arranged in hospital.

You may also be required to have a physical examination of your heart and lungs by the anaesthetist to make sure it is safe for you to have an anaesthetic. You may need to have some routine laboratory tests, such as urinalysis (tests of your urine), chest x-rays, or complete blood cell counts. These should reveal potential problems that might complicate the surgery if not detected and treated early. No testing may be necessary if you are in good health and younger than age 55.

Please answer all questions completely and honestly as they are asked only for your own wellbeing, so that your surgery can be planned as carefully as possible. If you are unsure of the names of any medications, bring them with you. You will be told whether or not to stop any medications at this preoperative clinic visit. For example, if you are taking aspirin-containing medicines or anticoagulants, they may need to be temporarily withdrawn or reduced in dose for two weeks before the procedure. If you can, try to stop smoking at least six to eight weeks prior to surgery.

Your eyes are also examined carefully; your vision in each eye is measured. Photographs of the lesion may be taken for documentation. Some insurance companies insist on this.

PLEASE NOTE: There is no such thing as a minor operation when this involves the removal of a lesion close to the eye. It is preferable to arrange the surgery on a separate occasion and not immediately following the consultation.

How long will I stay in the clinic?

Minor surgical procedures are performed as day cases. You should be able to undergo the procedure and be discharged within an hour.

What happens the surgery?

After surgery, the eye may be covered with a dressing which you should leave in place until the following morning. This will help to keep bruising and swelling to a minimum. Take a simple analgesic if required e.g. paracetamol. You should wash your hands thoroughly before removing the dressing and before touching the wound. You should clean the wound 3 times a day using cotton wool soaked in cool boiled water. Dry the area with the cotton wool and then apply antibiotic ointment 3 times a day for 2 weeks.

If you have undergone a biopsy the report will be sent to you and to your GP as soon as it has been received from the pathologist. If the lesion is benign and there are no problems you will not need to return to the clinic for a check but in the event of any roblems you should call the clinic and arrange a further appointment.