History of ophthalmologic conditions, including dry eye, excessive tearing, vision problems, thyroid eye disease, and Bell’s palsy

Personal or family history of skin malignancy or significant sun exposure

History of previous periorbital trauma, surgery, or facial radiation

Ophthalmic medications

Divide the periocular region into “zones” (Fig. 10.1)

Determine layers that have been lost

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  Full or partial thickness

  
  
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  Partial thickness: Skin, muscle, tarsus, and mucosa

  
  
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  Full thickness: <25%, 25–50%, or >50% of the eyelid

Evaluate laxity of the eyelid, canthal support, and any involvement of lacrimal system

Identify viable elements available for reconstruction (e.g., skin, muscle, tarsus, conjunctiva)

Vascularity, scarring, radiation damage, and severe actinic damage should be evaluated for the surrounding periorbital

Evaluate eyelid function

Establish the diagnosis: If not done earlier, a biopsy should be performed at initial visit

Confirm negative pathologic margins following resection prior to attempting significant reconstruction

Magnetic resonance imaging (MRI): Useful adjunct to determine extent of tumor and lymph node status in cases of aggressive tumor histology (e.g., perineural invasion or deeply invasive tumors)