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Overview
Skin cancer,
the most common type of malignancy, can develop on
any area of the skin exposed to the sun, including
the eyelids. In most cases, lesions occur on the
lower lids, but they can occur anywhere on the
eyelids, in the corners of the eye, under the
eyebrows, and in adjacent areas of the face.
Basal cell carcinoma is the most common type,
accounting for 90% of cases. Other eyelid cancers
include squamous cell carcinoma, sebaceous gland
carcinoma, and malignant melanoma. Together, these
account for 10% of eyelid malignancies.
Basal cell carcinoma
Approximately 75% of cases of basal cell carcinoma
of the eyelid occur on the lower lid. The lesion
usually develops as a small, firm, painless nodule
with a smooth, pearly appearance and may develop
telangiectasia (a reddish hue caused by dilated
capillaries).
Basal cell carcinoma of the eyelid progresses very
slowly. Metastasis is rare, but if left untreated,
the disease can spread to and destroy surrounding
tissue. Complete recovery is possible with
surgical excision, but basal cell carcinoma can
recur.
Squamous cell carcinoma
Squamous cell cancer
usually occurs on the lower lid. The lesion is
usually a raised, scaly patch of reddened skin. It
may resemble a scab that does not heal. As the
disease progresses, the lesion may bleed or drain
pus. Metastasis is rare, but it can invade local
tissue and metastasize.
Malignant melanoma
Malignant melanoma originates in melanocytes,
skin cells that produce melanin, the pigment
responsible for variations in skin color. There
are several different types of melanoma
and they vary in appearance. Two types commonly
occur on the eyelids. Lentigo maligna melanoma
(LMM) lesions are flat and tan with irregular
borders and become increasingly mottled as they
grow. Nodular melanoma (NM) lesions are
slightly elevated, blue-black, and resemble blood
blisters.
Lentigo maligna melanoma spreads slowly, remains
in superficial layers of skin, and does not
metastasize. Nodular melanoma is the most
aggressive type of melanoma. It grows rapidly and
is often fully invasive when diagnosed. It also
has a higher rate of systemic metastasis than
basal cell and squamous cell carcinomas
Sebaceous gland carcinoma
This rare cancer primarily affects the
meibomian glands of the eyelids and to a
lesser extent the Zeiss glands, which produce the
oily layer of the tear film. These tumors most
commonly occur in the upper eyelid and are usually
firm and painless, often with a yellow tinge.
Sebaceous gland carcinomas are highly aggressive
and frequently metastasize. They are often
mistaken for a benign condition, such as chronic
blepharitis
or a chronic chalazion (nodule formed by
inflammation of the meibomian gland). This delay
in diagnosis can result in metastasis to the orbit
(bony socket surrounding the eye) or to the lymph
nodes.
Incidence and Prevalence
In the United States, malignant tumors of the
eyelid occur most often in older Caucasians with a
history of prolonged sun exposure. Basal cell
carcinoma is the most common eyelid malignancy.
Squamous cell carcinoma accounts for 5% of eyelid
malignancies. Malignant melanoma
of the eyelid is rare, accounting for 1% of eyelid
skin cancers. Sebaceous gland carcinoma accounts
for 0.8% of eyelid tumors. Lentigo maligna
melanoma is the least common and typically occurs
in people over 70.
Risk Factors
The primary risk factor for eyelid cancer, with
the exception of sebaceous gland carcinoma, is
excessive exposure to sunlight. Older
people are affected more often because they have
had more exposure to the sun’s UV rays. Women over
age 60 and younger people who have had radiation
therapy to the face have the highest risk for
sebaceous gland carcinoma. Eyelid cancer is
prevalent among people of European descent with
fair skin because their skin provides little
natural protection against the sun. Hereditary
risk factors also may be involved.
Symptoms
Symptoms vary according to the type of skin
cancer, but in most cases, the lesions are
painless. They do not clear up on their own or
with topical ointments. Over time, they grow
larger and/or change shape and color. Sometimes
they bleed, develop a crust, or discharge pus.
Diagnosis
The initial diagnosis is made by examination with
a slit lamp microscope (instrument with a
high intensity light source attached to a
microscope) that allows the doctor to view the eye
under high magnification. If the lesion looks
suspicious, a biopsy is
done. This procedure involves removing a small
piece of the lesion and sending it to a laboratory
for examination. A biopsy is necessary to make a
definitive diagnosis.
Treatment
The most effective treatment is removal of the
entire tumor to minimize the risk for recurrence
and spread (metastasis). In a simple excision,
the lesion is excised (cut away) with a small
margin of healthy tissue. The healthy tissue is
removed to ensure that stray cancer cells are
removed. This technique is used for small, shallow
tumors.
Moh’s technique
is especially useful in treating cancer of the
eyelids. The lesion is removed layer by layer.
Each layer is examined microscopically for cancer
cells. Layers continue to be removed until
cancer-free tissue is reached. This slow procedure
helps preserve healthy tissue and produces better
cure rates and cosmetic results after surgery.
When surgery leaves a disfiguring scar or involves
removal of a significant part of the eyelid,
reconstructive surgery (link to ocuplastic
surgery) can greatly improve the eyelid’s function
and cosmetic appearance. This type of surgery is
performed by an ophthalmologist with training in
plastic surgery.
Other Treatments
There are several treatment options for patients
who are poor candidates for surgery and those who
refuse a surgical procedure. If the lesion is
superficial, a laser may
be utilized to burn it off. Lasers have been used
with success in basal and squamous cell carcinomas
that have not penetrated too deeply into the skin.
Laser treatment may not be appropriate because of
the location of most eyelid tumors.
Cryosurgery
involves using liquid nitrogen to freeze cancer
cells. It does not ensure complete tumor
eradication, however, and the rate of recurrence
is high and there may be scarring.
Systemic chemotherapy
and/or local radiation
can also be used, but they are not as effective as
surgery. If the tumor has metastasized, radiation
and chemotherapy may be needed to treat the
disease. These modalities produce several side
effects, such as:
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Gastrointestina disorders
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Anorexia (loss of appetite)
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Diarrhea or constipation
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Esophagitis (inflammation of the esophagus)
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Mouth sores
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Skin disorders
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Dryness and itching
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Hair loss
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Rash
Prevention
Staying out of the sun or shielding the
eyes with sunglasses can help prevent
cancer of the eyelid. Protecting the eyes from
prolonged sun exposure may also offer protection
against other disorders that affect the eye.
It is important to be aware of lesions or
irritation around the eyes, especially if they do
not heal or if they change shape and color.
Blepharitis or a chalazion that does not improve
with treatment should be reported to a physician.
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