The Ophthalmic Office Procedures Handbook

CHAPTER 7

115

Eyelid Biopsy

FIGURE 7-3 ( continued )

● Lid margin lesions A shave biopsy is recommended for these lesions. Being too aggressive with removing the lesion or cauterizing too much to stop bleeding can leave a notch in the lid. If there is a con cern for malignancy, the specimen is sent in formalin to a pathology laboratory. If the lesion is reported back as malignant, the recommendation would be for the patient to be referred to an oculoplastics specialist and to have more surgery to be sure all the tumor cells are gone. The goal of the specialist would be to remove the remaining tumor cells and confirm under the microscope that the margins were clear and then to repair the lid in such a way that there is no notch and the lid is cosmetically pleasing to the patient. If there is no concern for malig nancy, the specimen is discarded in a medically appropriate way. If the clinician is too aggres sive, a notch can occur. However, if the patient has a notched lid that is obvious in exchange for a benign lesion, then the patient is not happy, which can make the doctor unhappy as well. It is best to inform the patient that you will remove the lesion and make the tissue flush with the lid margin. Benign lesions rarely grow back enough to be noticed again. But if that happens and the lesion returns, the patient may need to have a full-thickness lid resection by a specialist to be sure there are no cells left. That would be the safest and most cosmetically pleasing way to remove every cell of the benign lesion and not to leave a lid notch. Most of the time, the benign lesion will not return if the examiner gets most of the lesion. ● Lash line lesions The recommended procedure would be a shave biopsy, either excisional or incisional . The patient needs to be aware that in removing the lesion, some lashes may be lost. This is not a huge problem in the lower lid, but can be obvious in the upper lid, especially in female patients. The goal is to take as much of the lesion the examiner can without damaging too many lash follicles. Some lesions of the lash line can be grasped with the forceps and lifted and the entire base cut and cauterized, thus removing the entire lesion. Some can only be debulked (incisional) without losing lash follicles.

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