20 Cases Of Eyelid Margin Pigmented Nevus Excision And Cosmetic Reparation

Background:Eyelid margin pigmented nevus is a benign lesion that pigment cells affect eyelid margin.It brings patients inconvenience and stress on daily life,for it has an effect on appearance and eyesight, sometimes even causes corneal irritation,so it needs treated timely,even though it does not has a high malignant transformation rate.Nowadays there are so many methods to this disease,as usually deal with skin pigmented nevus,such as merely lesion shaving,liquid nitrogen frozen,iontophoresis,CO2 laser,surgery.All of them will lead to eyelid defection. Eyelid defection not only has a bad influence on appearance,but also may lead to exposure keratitis even corneal ulcer,the worst blind.With the improvement of Plastic surgery techniques,and related area, eyelid defect repair methods are diverse, and each of them has advantages and disadvantages.We need to consider the cause, location,range,eyesight,surroundings,general conditions,when repair eyelid defect.There are diverse operating methods,such as straight suture closure,local flap,axis flap,skin grafting,free skin flap and so on.This article is a study of skills about how to excise eyelid margin pigmented nevus thoroughly and reconstruct the defect perfectly.Objective:Study 20 cases on Eyelid margin pigmented nevus,excision andreparation,to generalize the methods and experience.Methods:From 1,2008 to 10,2015 there were 20 eyelid margin pigmented nevus patients who have been treated in our hospital,male 3,female 17,aged from20~38,average 27.9.Total 20 eyes,upper eyelid 8 eyes,lower eyelid 12 eyes.Full thickness lesion 15 eyes,only anterior layer 5 eyes.The surface area ranges from 2.0 ㎜×2.0 ㎜ to7.0 ㎜×6.0 ㎜.The operations were all carried out with the help of eye gauge.All of the patients were followed up 1,3,6,12 month after operation, observe the lesion recurrence,eyelashes continuity,eyelid margin continuity, eyelid margin angular deformity, eyelid ectropion, entropion and recession,scar,bilateral symmetry,eyelid activities,comfort,and then appraise the results.(no control group).Results:All the flaps were survived,and incisions were healed at one-stage. None of the 20 cases were found lesion recurring during the 1,3,6,12 month follow-up, eyelid margins were continuously,no notches,no eyelid ectropion,no entropion or recession, bilateral symmetry was excellent,eyelid activities were unaffectedly,all felt comfortable. 18 patients’ eyelashes were all in good condition,2 patients lost a little eyelashes,which can not be observed without a close look. 19 patients’ incision scars were concealed and unconspicuous,only 1 patient’s incision showed light scar hyperplasia.Whole great satisfaction were achieved.Conclusion:1. With the help of eye gauge, Mohs micrographic technique,lesions are carried away totally and normal structures are maximizely reserved.Which simplified the reparation of eyelid defect.2.Design under-eye puffiness incision as the auxiliary incision of the lower-eyelid defect reparation, avoid vertical tension which can cause eyelid ectropion and recession,also the incision scar compares to “Z”flap and tongue-like flap is concealed and unconspicuous.3.When the lesions are only confined in the anterior layer of the eyelid margin,we choose rectangular advance flap.When dealing with “dog’s ear”,if oriental eyelid patient the auxiliary incision is put near the margin of the eyelid instead of the other side,so it will not contribute to unexpected double eyelid and also the scar is hidden,if double eyelid patient, the auxiliary incision is put overlap the eyelid line,in order to avoid new scars.4. On eyelid margin, surgery is better than CO2 laser in dealing with pigmented nevus,which has a higher aesthetic effect and lower malignant transformation risk.