The rapid pearl session explored a case that challenged surgeons to preserve the function of the tarsal plate and musculature attachments.
A patient case in need of Mohs surgery on a previously excised sebaceous carcinoma located on the posterior lamella was presented during a rapid pearl session at the 2023 American College of Mohs Surgery Meeting in Seattle, Washington.1 The patient was a 55-year-old man with a history of Muir-Torre Syndrome, which is a rare, inherited disorder that causes tumors to form in the oil glands in skin and internal organs.2
The right tools are essential for the delicate posterior lamella. A Desmarres retractor can be used to evert the upper eyelid and provide retraction and surgical exposure of the conjunctival surface of the treatment area. For the same benefit, a chalazion clamp can also be used depending on the tumor location. Neither of those tools are typically in a standard dermatologic surgery kit and need to be requested or ordered separately. There are other ways to accomplish the same result with a standard toolkit though.
The improvised solution provided in the rapid pearl session was to place a suture through the anterior lamella at the lash line. The blunt, rounded edge of the scalpel handle can be applied to the anterior surface of the eyelid. This solution, in the case of the 55-year-old man presented, resulted in effective tumor removal, subsequent reveal of the posterior lamella, and a stable platform to allow for accurate Mohs excision.
Pearls to Take Away From the Case
When a sebacious carcinoma arises from the Meibomian glands on the eye’s tarsal plate, a Mohs excision using a posterior approach is sometimes necessary. Presenters emphasized how temporary suture retractors and readily available surgical equipment can be used in unique ways to overcome challenges in Mohs surgery. In between anteriorly-placed suture retractors and an anteriorly-positionedscalpel handle, the posterior lamella can still be accessible and stabilized. This case’s technique and approach allowed the surgical team to preserve the function of the tarsal plate and musculature attachments. Reconstruction complexity and recovery were also minimized.
Did you attend ACMS 2023? Email DTEditor@mmhgroup.com. We would love tohear your biggest takeaways and pearls you will be putting to practice at home.
1. Heath M, Leitenberger J, Neill B. Practical Pearls for Excising Tumors of the Posterior Lamella. Presented at the 2023 American College of Mohs Surgery Meeting; May 4-7, 2023; Seattle, WA.
2. Ozgur O, Kothapudi VN, Rostami S. Lower Eyelid Reconstruction. StatPearlsPublishing LLC; 2022.