Eyelid Skin Cancer

What is Eyelid Cancer?

The term "eyelid cancer" refers to any cancer that develops on or in the eyelid.

The eyelids, and more commonly the lower eyelid, are sites of potential skin cancer due to sun exposure. The skin cancer may be difficult to recognise at first due to its initially small size. It may appear as only a small skin-coloured bump. During your consultation, a slit lamp examination will provide a magnified view. If suspicious features are seen, such as ulceration or the loss of eyelashes, the lesion will be biopsied.

A biopsy is performed in the office under local anaesthetic. A small portion of the skin lesion is removed and sent to the pathologist for testing. If cancer is identified within the specimen, surgical excision of the entire lesion is required.

Skin cancer excision is performed at a day surgery under local anaesthetic with sedation. A pathologist will attend the operation to check the excised lesion to ensure its complete removal. The eyelid is then reconstructed to repair the defect left by the excised skin cancer. Different techniques are required, depending on the size and location of the defect and may include a skin flap or graft. The smaller defects require less reconstruction, thus early detection is the key.

Causes Of Eyelid Cancer

Risks factors associated with developing eyelid cancer are:

UV radiation exposure. Both ultraviolet A (UVA) and ultraviolet B (UVB) radiation are emitted by the sun. Sunburn is caused by UVB radiation, which also contributes to the growth of basal cell carcinoma, squamous cell carcinoma, and melanoma.
Fair Skin. Less melanin (pigment) in the skin means less protection from UV rays. Eyelid cancer is more common in people with fair hair and light-coloured eyes who have skin that doesn't tan but freckles or burns easily.
Gender is an important factor to consider. Skin cancer rates among white men have risen in recent years.
Age is a factor. The majority of basal and squamous cell cancers develop after the age of 50.
A history of sunburns or skin that is easily damaged. Eyelid cancer is more likely in skin that has been burnt, sunburned, or injured by disease. Squamous cell and basal cell cancers are more common in people who have been exposed to the sun for a long time.

Symptoms Of Eyelid Cancer

The following symptoms may be experienced by people who have eyelid cancer. These signs may be also exacerbated by something other than cancer.

A variation in the colour of the skin of the eyelids
An inflammation of the eyelid that lasts for a long time
An unhealed ulceration (a break in the skin) on the eyelid
A growth on the eyelid which bleeds or itches

Types Of Eyelid Cancer?

The following are the most common forms of eyelid cancers:

Basal cell carcinoma. Basal cells are found in the lower region of the epidermis (skin). Cancer arising from these cells is the most common type of eyelid cancer and tends not to spread beyond the nearby area.
Sebaceous carcinoma. This is a rare eyelid cancer mostly occurring in older adults, arising from sebaceous glands.
Squamous cell carcinoma. Squamous cells make up the majority of the epidermis' top layer. Cancer arising from these cells are the second most common type of eyelid cancer and uncommonly spread beyond the nearby area.
Melanoma. Melanocytes, which produce the melanin that gives skin color, are spread across the epidermis' deepest layer. Melanoma is a cancer that begins in the melanocytes and is the most dangerous due to the possibility of spread to other parts of the body.

How Is Eyelid Cancer Diagnosed?

During your consultation, a slit lamp examination will provide a magnified view. If suspicious features are seen, such as ulceration or the loss of eyelashes, the lesion will be biopsied.

A biopsy is performed in the office under local anaesthetic. A biopsy is a procedure in which a small amount of tissue is removed and examined under a microscope. A small portion of the skin lesion is removed and sent to the pathologist for testing. If cancer is identified within the specimen, surgical excision of the entire lesion is required. A biopsy is the only way to make a definitive cancer diagnosis for most forms of cancer.

How Is Eyelid Skin Cancer Treated

Eyelid skin cancer is treated by surgical excision at day surgery. This is performed under local anaesthetic and sedation and is very comfortable for the patient. The eyelid tumour typically spreads microscopically extending beyond the margin of the visible lump. When excising a skin cancer, a "margin" of normal looking skin is excised, to capture this spread and ensure all the tumour cells have been removed. To check that this margin is adequate, a pathologist attends the operation for a "frozen section". In very thin layers, the pathologist examines the edge of the margin of skin under a microscope, to check for any remaining cancer cells. If there are no more residual cancer cells at the edge of the margin, it is likely the cancer has been completely removed. If there are cancer cells still visible at the edge of the margin, a further margin will be excised as part of the same operation. This allows for complete excision of the skin cancer while preserving as much normal eyelid as possible. The more normal eyelid that remains, the simpler the reconstruction will be. Also, by ensuring all the skin cancer is removed, this lowers the rate of recurrence of the skin cancer, which is already very low. The reconstruction will depend on the size of the defect, but often involves a skin graft taken from the upper eyelid (where there is often excess skin) and/or a repair of the tendon holding the eyelid in position. Surgery is usually curative and results in a very good cosmetic and functional outcome.

Less commonly, treatment can also involve the following:

Radiation Therapy. To destroy cancer cells, radiation therapy uses high-energy x-rays or other forms of radiation.
Chemotherapy and targeted therapy: In some basal cell carcinomas, an immune-response modifier such as topical imiquimod cream has been shown to be effective.

What If The Eyelid Skin Cancer Is Untreated?

Basal cell carcinoma is the most common form of eyelid cancer. The majority of basal cell carcinomas can be surgically removed. Many older patients, on the other hand, would prefer to ignore these slow-growing tumors, especially as they are unlikely to metastasise. It's important to remember, however, that if left untreated, these tumours could spread around the eye, into the orbit, sinuses, and potentially brain.

Squamous cell carcinoma is more likely than basal cell carcinoma to spread, potentially along nerves, and should not be left untreated. Melanoma is much more likely to metastasise and can potentially be fatal. Therefore it should not be left untreated.