Stable Upper Eyelid after 2 Successive Tarsoconjunctival Flaps

A 70-year-old male with history of multiple cutaneous squamous cell carcinoma throughout the body presented with a left lower lid margin squamous cell carcinoma. The lesion was excised via Mohs surgery elsewhere, and the defect was reconstructed with a tarsoconjunctival flap (Hughes flap). The lesion recurred, and the patient had a second Mohs surgery for excision. For reconstruction, a second tarsoconjunctival flap spanning the entire horizontal distance of the upper lid was done. The remaining 2–3 mm of upper tarsus provided good support of the upper lid. Careful planning may allow for successive tarsoconjunctival flaps if needed in the future.