As an oculoplastic surgeon in Denver, Colorado, I perform cosmetic eyelid surgery but also perform reconstructive surgery. The two go hand in hand. A surgeon who performs cosmetic surgery has a particular attention for cosmetic appearance. That is extremely important in cancer reconstruction. An eyelid surgeon who performs reconstructive surgery will have a better knowledge of anatomy and surgical skills than one who tries to focus "just on cosmetics". That is a simple fact that many surgeons will not tell you. Though reconstructive cases are challenging at times, it is critical for an eyelid surgeon to have the best skill set. Eyelid cancer reconstruction is a large part of my practice in Denver and these are some facts to reduce the amount of surgery I do. I hope in the future I never have to do any eyelid surgery reconstruction after basal cell, squamous cell or melanoma eyelid cancer removal but unfortunately that may not be the likely case.

Skin cancer is very common and we often hear in Colorado and Denver in particular that it is important to have skin care protection such as skin block, hats and clothing when in the sunlight. So, in 2016 what are the key facts that are important to know for patients in Denver to prevent eyelid and facial cancer?

Here are some key facts to know:

There are 1.5 million new skin cancers this year in the United States alone. That is a lot of skin cancer. Skin cancer is mostly preventable with protection of the skin.

What are the types of skin cancer on the eyelid that patients in Denver and Colorado get? The break down is as follows:

Basal cell carcinomas (80%)

Squamous cell carcinomas (15%)

Melanomas (4%)

Sebaceous cell carcinoma (1%)

The most common eyelid cancer is basal cell though other types of cancer can exist. Melanoma and Sebaceous cell cancer of the eyelid are certainly the least common but most deadly. Most deaths from eyelid cancer come from these two types of eyelid cancer.

What are the risk factors for eyelid cancer for Colorado patients?

Elderly Caucasian

Light complexion/Blue eyes

Actinic damage

Cigarette Smoking

Older white patients are more at risk for eyelid cancer because they don’t have the melanin layer of protection that patients of color have. Specifically white patients with light skin tones, blue eyes and red hair are much more susceptible to eyelid cancer itself. It is not that Latino, African American and Asian patients don’t get eyelid cancer. It is just less common. In fact Latino patients are much more likely to be diagnosed with eyelid cancer later and in a more advanced stage. The more sun damage that patients have (sunburn/sun exposure) increases the risk. People who tan outside or even work outside are at greater risks for eyelid cancer. Finally, cigarette smoking increases the risks of all cancers and even skin cancer. If you are cigarette smoking in 2016 simply put, you need to stop because it will kill you.

Living in Colorado increases the risks of skin cancer and eyelid cancer for very specific reasons. First there is greater UV exposure and second at the higher altitude we are exposed to greater radiation because of a thinner ozone layer.

Here are some facts about Colorado patients and skin and eyelid cancer that are important to know if you live here:

45% of Caucasians in Colorado had a sunburn within the last year

15% higher rate of melanoma compared with rest of country

13th rank of skin cancer in US

Pitkin County is one of the highest skin cancer rates in the nation

Pitkin County where Aspen Colorado is has one of the highest rates of skin cancer in the country because of the population that lives there along with the high altitude. Cities with an elevation over 6000 feet are at increased risk of melanoma and skin cancer. Additionally, high altitude cities have more people that enjoy outdoor activities so they have more exposure. It is important if you live in Pitkin County to get an eyelid lesion or facial lesion that is abnormal checked out immediately. The 45% of caucasions in Colorado who suffered a sunburn is completely preventable with proper protection.

What are the risk factors for developing skin cancer?

Burns in Childhood

More than 90% of non-melanoma skin cancer is caused by sun exposure

Unprotected exposure

One sunburn in childhood doubles the risk of skin cancer in patients. As one can see, a child who suffers a sunburn increases the risk dramatically of developing skin cancer as they get older. Often children don’t want skin protection on their face because of the irritation. Parents should manually apply sun block and insist schools and daycares apply sunblock for children to reduce this risk.

Only 33% of women and 10% of men wear daily sunblock. Windows allow UV light to come through and UV exposure can occur even in fog.

What about the incidence of eyelid and skin cancer in patients? Has skin cancer gone up or down in Colorado and Denver? How common is the disease? These are the facts that every American should be aware of.

Incidence of eyelid cancer of has tripled since 1980

1 in 5 Americans will be diagnosed with skin cancer (1 in 3 Caucasians)

Men > Women 2 : 1

Dramatic Increase in People < 30:

Melanoma has tripled

Squamous cell carcinoma doubled

Basal cell carcinoma have doubled

As can be seen the incidence of cancer is continuing to rise. Denver patients are doing more outdoor activities with sun exposure. The most important thing is to reduce sun exposure with sunblock, protective clothing and hats. Sunglasses are helpful as well. Men tend to do more outdoor activities and as a result have a higher rate of eyelid cancer. Young people in particular have an increased risk of eyelid cancer as well. Education on eyelid cancer in Denver Colorado is key. Monitoring the face, neck and eyelids for eyelids are essential to catching the disease early.

A patient after the eyelid cancer which was self described as a "small spot" was completely removed showing almost complete loss of the lower eyelid.

A patient after the eyelid was reconstructed with upper to lower eyelid tissue transfer was complete.