Eyelid Reconstruction Following Mohs Micrographic Surgery: Outcomes, Comparison of Techniques and Complications, an Asian Perspective

Author(s): Daniel Yuxiang Chin, David Zhiwei Law, Llewellyn Kuan-Ming Lee

Purpose: To evaluate the surgical outcomes, complications, and recurrence rates in patients undergoing eyelid reconstruction following Mohs micrographic surgery. Methods: This single-institution retrospective study included 25 patients who underwent eyelid reconstruction after Mohs surgery between January 1, 2014, and December 31, 2022. Data on demographics, lesion characteristics, surgical techniques, and outcomes were analysed. Results: The mean patient age was 67.2 years (range: 49–89); 72% were male and 28% were female. Majority were Chinese (68%) and the rest comprised other races (32%). Lesion sizes were classified as small (<20 mm, 36%), medium (20–30 mm, 40%), or large (>30 mm, 24%). The majority (88%) were basal cell carcinomas, with the lower eyelid most commonly affected (96%), particularly the medial canthus (50%). Reconstruction was successful in all 25 cases, with no evidence of tumour recurrence over a median follow-up period of 36 months. Reconstruction techniques included full-thickness skin grafts (upper inner arm: 64%; upper eyelid: 12%), upper eyelid tarsoconjunctival grafts with lower eyelid myocutaneous flaps (16%), the modified Hughes procedure (4%), and direct closure (4%). Complications requiring repeat surgical intervention occurred in 3 (12%) of cases, while minor complications managed conservatively occurred in 2 (8%). Post-operative issues included lagophthalmos (4%), medial ectropion (8%), and graft dehiscence (8%). Conclusion: Eyelid reconstruction post-Mohs surgery can be successfully performed through various techniques tailored to defect size, location, and lamella involvement. Asian eyelids with prominent medial epicanthal folds, may benefit from full-thickness skin grafts. Close coordination with the Mohs surgeon and timely defect closure are essential to optimizing results.