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Chronology

What will happen after a basal cell carcinoma is suspected?

  1. Detect eyelid/face growth
  2. Confirm the diagnosis by biopsy
  3. Refer to Dermatologic surgeon DrHabib Kurwa or Richard Barlow at St Thomas' Hospital for Mohs' micrographic excision of tumour.
  4. Receive a date by post for excision of the tumour under local anaesthesia at St Thomas' Hospital
  5. Reconstruction by Miss Olver's Oculoplastic team at the Western Eye Hospital, the Charing Cross Hospital or the Wellington Hospital on the same day / one day later

The diagnosis is confirmed by Miss Olver who takes a small incisional biopsy under local anaesthesia at the Western Eye Hospital, the Charing Cross Hospital or Wellington Hospital. The small part of the tumour is examined microscopically (histopathological analysis).

The result of the incisional biopsy is available within two weeks. If your lesion is confirmed as a basal cell carcinoma, we will refer you to a Consultant Dermatologic Surgeon at St John's Institute of Dermatology at St Thomas' Hospital, either Dr Habib Kurwa or Richard Barlow who are two specialist doctors who will remove your tumour using Mohs' micrographic surgery on a Monday or Wednesday morning under local anaesthesia. Take a book to read or a friend to talk to and bring a snack and drink to keep you going as there is some waiting to do whilst the tissue sample is examined — this may take between one and three hours.

It is necessary for you to travel to St Thomas' Hospital in central London for Mohs' micrographic surgery is this is very specialized treatment only available at a small number of units in the country. We believe it is the best treatment available for you.

Once you have had the tumour completely excised, an eyepad or dressing is placed on the defect created. You'll be transferred back to the Western Eye Hospital, Charing Cross Hospital or Wellington Hospital for reconstructive surgery of the defect left by the Mohs' surgery. This is usually done on the same day or following day. If you live next to the hospital and your reconstruction is planned for the next day, you can go home then return at the agreed time. If you live far away, if you prefer, or if you live by yourself we recommend that you are admitted to Hospital. When you get back to the Hospital Miss Olver or one of her Oculoplastic assistant surgeons will examine the wound to determine the precise type of reconstructive surgery needed.

Reconstruction is normally done under local anaesthesia. You can have light sedation as well during the surgery to help you feel relaxed. If the defect is very big and your reconstruction is planned for a general anesthetic you must have nothing to eat or drink for at least 6 hours before your planned reconstructive surgery.

Please avoid aspirin for two weeks prior to surgery if this is allowed medically.

After the reconstructive surgery you are likely to be discharged home on the same day or the following day. There will be a pressure bandage over the eye and around the head for up to one week. Arrangements will be made for you to return to the Oculoplastic clinic for follow up and for the dressings and sutures to be removed.

Consultant Dermatologic Surgeons at St John's Institute of Dermatology at St Thomas' Hospital, Drs Habib Kurwa and Richard Barlow (back row) and their nursing staff: Gillian Ogden and Julie Smithson.