Eyelid tumors

• What are the symptoms?

Eyelid tumors appear as lumps or elevations of the skin or as nodules. The main goal in the evaluation of these lesions is to differentiate malignant from benign lesions. In general, the majority of malignant tumors affecting the eyelids and surrounding areas are slowly enlarging, destructive lesions that distort or frankly destroy eyelid anatomy.

In some cases, eyelashes are distorted or missing. The cancerous area may be ulcerated, may bleed or crust and the skin may be distorted. There is no associated pain. There are a number of subtle features that can help to differentiate malignant from benign eyelid tumors.

In some cases, however, it can be extremely difficult to make the correct diagnosis of an eyelid lesion without a biopsy.

• What are the causes?

Skin cancer is normally caused by excessive exposure to sunlight. The face, eyelids and arms are the main areas to be affected and fair-skinned people are much more likely to develop skin cancer than those with darker skin. Rarely, skin cancer can be an inherited condition.

• What eyelid tumors can occur?

The most common malignant tumor in the periocular area is basal cell carcinoma (BCC). It is also known as rodent ulcer, and is a relatively indolent tumor with virtually no metastatic potential. Less common tumors include squamous cell carcinoma, sebaceous gland carcinoma, melanoma, lymphoma, Merkel cell tumor, and Kaposi’s sarcoma (the last three being very rare).

Squamous cell carcinoma (SCC) is the second most common malignant tumor in the periocular area. It may appear as a painless nodule, or a sore that won’t heal. BCC and SCC spread locally, are slow-growing but can invade neighbouring tissues.

They do not spread (metastasize) into non-adjacent areas. Sebaceous gland carcinoma is a more serious but rare form of skin cancer. It may appear as a recurrent chalazion, persistent eyelid inflammation, chronic red eye or thickening of the eyelid.

Melanoma is also less common but more serious form of skin cancer. A mole that bleeds, becomes tender, changes size, shape or color needs to be seen urgently by a physician. Sebaceous gland carcinoma and melanoma can metastasize to other parts of the body through the blood stream or lymphatic system.

Early diagnosis can significantly reduce morbidity associated with malignant eyelid tumors.

• Can eyelid tumors pose a risk to the eye and vision?

Yes - either as a result of infiltration and distortion of the eyelid, direct involvement of the corneal surface, and/or spread into the orbit. In addition, if left untreated for a long time, complete excision can result in a larger defect, this necessitating more extensive reconstructive surgery.

• What is the treatment of eyelid tumors?

Eyelid tumors are generally managed with complete excision and subsequent reconstructive surgery. To prevent a recurrence, the tumor should be removed completely, while as much healthy tissue as possible is preserved. The general approach is known as margin-controlled excision, where the edge of the cancer is identified and the growth within this area is removed. It normally takes place under a local anesthetic.

Reconstruction methods include allowing the defect to heal naturally, direct closure of the defect, or by using a combination of local tissue flaps, skin grafts and /or other grafts (such as ear cartilage or a hard palate graft).

Radiation therapy and cryotherapy (freezing with liquid nitrogen) may be useful in treating certain types of cancers in patients who cannot tolerate surgery, or in addition to surgery, in more aggressive type of skin cancers.

Patients with certain tumors (SCC, sebaceous cell carcinoma, and melanoma) also require a general oncological review to exclude disease elsewhere, and this may include surgery to investigate the presence of lymph node involvement in the neck.

• What is the follow up period after surgery?

Because of the risk of recurrence of an eyelid tumor, patients are usually reviewed regularly (at increasing intervals) for up to five years after treatment.