'Kissing' squamous cell carcinoma occurring simultaneously in the upper and lower eyelids

Eyelid squamous cell carcinoma (SCC) typically arises from eyelid skin; however, simultaneous involvement of both the upper and lower eyelids has not been previously reported. A 74-year-old Caucasian man presented with two distinct right eyelid masses: a 2-cm ulcerated upper eyelid lesion and a 1.5-cm lower eyelid lesion with prominent telangiectatic vessels. Biopsy confirmed SCC, and Mohs surgery achieved complete tumor removal. The resulting anterior lamellar defects measured 3.5 × 1.2 cm in the upper eyelid and 2.5 × 0.9 cm in the lower eyelid. Reconstruction was performed using a 7 × 2 cm full-thickness skin graft harvested from the supraclavicular region. At 3 months, there was no evidence of recurrence, eyelid function remained normal, and the cosmetic outcome was satisfactory. This rare presentation highlights the reconstructive challenges of extensive dual-eyelid SCC and emphasizes meticulous surgical reconstruction and long-term surveillance for recurrence and potential complications.