Cancers of the Eyelid

Cancers of the skin of the eyelid are fairly common.

Basal cell carcinoma
Over 90% of all malignant eyelid tumors are basal cell carcinomas (BCCA). The lower eyelids are primarily involved in over 70% of cases, followed by the medial canthus, upper eyelid, and lateral canthus. BCCA usually presents as small firm raised nodules with an ulcerated center with rolled pearly translucent margins with fine telangiectatic vessels. This type of cancer causes extensive local destruction and can recur locally, if inadequately excised. However, these tumors generally do not metastasize to lymph nodes or distant organs.

Squamous cell carcinoma
This form of skin cancer occurs less frequently than basal cell carcinoma but it is more aggressive. It can metastasize to regional lymph nodes and even produce systemic metastasis. Wide excision of these tumors is the primary treatment. Sometimes when there is extensive involvement or adequate margins are not obtained, radiation therapy or other treatment modalities may be used

Malignant melanoma of the eyelid skin
This is a relatively rare cancer of the eyelid and accounts for about 1% of all eyelid malignancies. As with cutaneous melanomas elsewhere in the body, these lesions appear pigmented and show growth and change in borders with time. The principles of treatment for malignant melanoma in other locations apply for malignant melanoma of the eyelid skin as well. The tumor thickness should be identified via a biopsy. That usually determines the required margin of resection. The thicker a tumor (on histopathologic sections) the higher the likelihood of local recurrence and distant metastasis. Complete surgical excision of these tumors with 5-10 mm margins is recommended. The patient also needs to have periodic chest X-rays and other laboratory studies to rule out distant metastasis.

Meibomian gland carcinoma
This is another rare type of cancer involving the eyelids. It primarily affects the meibomian glands of the eyelids. These are sebaceous glands that normally produce the oily layer of the tear film. Meibomian gland carcinomas can be mistaken with some benign conditions such as a chalazion (or more commonly known as a "sty"). Any "sty" that does not heal and resolve with medical treatment or surgical drainage should be biopsied to rule out meibomian gland carcinoma. The treatment of meibomian gland carcinoma consists of surgical excision and long-term monitoring for regional lymph node or distant metastasis.

Reconstructive surgery can be performed after excision of most eyelid cancers and usually leads to acceptable functional and cosmetic outcomes. This is best done by an ophthalmic plastic surgeon (oculoplastic surgeon). This type of surgeon is an ophthalmologist who has special training in plastic surgery of the eyelids and periocular tissues as well as surgery of the lacrimal drainage system and the orbit.