What is eyelid cancer?
The eyelid skin is the thinnest and most sensitive skin on the body, and is easily damaged by sun exposure. The eyelid region is also one of the most common sites for skin cancers—in fact about 5-10% of all skin cancers occur on the eyelid. Ninety percent of these tumors are basal cell carcinomas, a slow-growing type of skin cancer that does not spread to distant sites in the body. Squamous cell and sebaceous gland carcinomas, and malignant melanoma account for the other 10%. These types of cancer are more aggressive than basal cell carcinoma, and can spread to nearby lymph nodes and other parts of the body.
The lower eyelid is the most common site for cancers; more than half of eyelid cancers develop there. Cancers occur less frequently on the upper eyelid and eyebrow, in the inner corner of the eye, and, rarely, in the outer corner.
What are the symptoms of eyelid cancer?
Symptoms of skin cancers that develop on the eyelid include:
- A bump that is smooth, shiny, pearly or waxy, or firm and red
- A sore or lump that bleeds or develops a crust or a scab
- A flat, flesh-colored or brown scar-like lesion
- A rough and scaly red or brown patch
- An itchy or tender flat spot with a scaly, crusted surface
- A stye that does not heal
- Loss of eyelashes
Any nodule or lesion on the eyelid that grows, bleeds, ulcerates, or does not heal should be evaluated.
How are eyelid cancers diagnosed?
Ophthalmologists carefully examine any abnormality on the eyelid to diagnose cancer, and usually confirm the diagnosis through a surgical biopsy. If the doctor suspects that the cancer has spread beyond the eyelid he or she may also use additional diagnostic tests including:
- imaging tests, such as CT or CAT (computed axial tomography) scans or MRI (magnetic resonance imaging) scans.
- sentinel lymph node biopsy. Surgeons remove the sentinel lymph node, the regional node to which cancer is likely to spread, and analyze it for the presence of cancer cells.
Early detection is essential, because some of these cancers have the ability to infiltrate inward along the deeper layers of the skin and through the bones and sinuses around the eye.
What are the treatment options for eyelid cancer?
Ophthalmologists treat tumors on the eyelid using Mohs microsurgery or frozen section control. In both procedures surgeons remove the tumor and a small margin of skin around it in very thin layers, examining each layer for tumor cells as it is removed, ensuring the best removal of cancer and the least amount of healthy surrounding tissue, and decreasing the rate of recurrence. With early diagnosis and treatment using one of these surgical approaches, the prognosis for most eyelid cancers is good, with a low chance of recurrence. After the tumor is removed reconstructive surgeons can often repair the site where the tumor was removed, and achieve a very good cosmetic and functional result.
Treatment may also include:
- Radiation therapy: Radiation therapy uses high-energy x-rays or other types of radiation to kill cancer cells. When skin cancer near the eye is treated with radiation, ophthalmologists shield the eye structures with a corneal shield, which is placed between the lids and globe.
- Chemotherapy and targeted therapy: In some cases ophthalmologists may use topical chemotherapy in the form of eye drops to use after the surgical area has healed. An immune-response modifier such as the topical imiquimod cream has also been shown to be effect in some basal cell carcinomas.
- Cryotherapy: the localized use of extreme cold produced by liquid nitrogen (or argon gas).
What steps will prevent eyelid cancer?
The best way to protect the delicate skin around the eyes from damaging light from the sun is to wear sunglasses that block ultraviolet light and a wide-brimmed hat. Use a broad spectrum, SPF 15+ moisturizer on the eyelid region rather than sunscreen, since the eyelid skin will absorb moisturizer better than sunscreen.