Malignant eyelid tumours
Description
By far the most common malignant eyelid tumour is the basal cell carcinoma (BCC) (approximately 85%) This is the most common human malignant tumour. Approximately 90% occur on the head and neck, with 10% on the eyelids. It grows slowly and is locally invasive and destructive but does not metastasise. Risk factors are age, sunlight exposure, fair skin, smoking, immune-deficiency and very rarely inherited genetic defects (Gorlin-Goltz syndrome).
Rarer tumours include squamous cell carcinoma (SCC), sebaceous gland carcinoma (SGC), and melanoma. In contrast to BCC, SGC and melanoma often grow rapidly and all may metastasise. SCC may arise from previously sun-damaged skin (actinic keratosis). SGC usually arises from the meibomian glands. SCC and melanoma may also arise from the conjunctiva. All carry a significant mortality risk.
Clinical Features
An enlarging persistent eyelid/peri-ocular lump
Intermittent bleeding and crusting
Loss of eyelashes or distortion of eyelid margin
Dilated blood vessels at edges with central ulceration are characteristic of BCC
Pigmentation may be seen with BCC and is usually present with melanoma
Management
See ophthalmologist with experience in oculoplastic surgery, urgently if SGC or melanoma suspected.
Surgical removal is usually required. Surgery aims to completely remove the tumour, with the tissue being sent for histological examination under a microscope to confirm that this has been achieved. Once the tumour has been completely removed, reconstructive surgery is usually necessary. Occasionally, the wound can heal on its own through a process called granulation. More commonly, reconstructive surgery is performed to make a new eyelid or repair the defect. Depending on the size, location and histological technique used, this may take place immediately after removal of the tumour, later the same day or 1-2 days later. Many excellent techniques are available to reconstruct almost any surgical defect. The operation will be specifically tailored to the defect that resulted from the removal of the tumour.
Regardless of technique, the goals remain the same: to reconstruct the eyelid so that it functions properly, protects the eye, preserves vision, and has a satisfactory cosmetic appearance. Any form of therapy for eyelid skin cancer will leave a scar. However, an effort is always made to minimize scarring and obtain the best possible cosmetic results. After surgery, the healing process may take six months to one year.
Alternative treatments are not usually appropriate around the eye but include:
Cryotherapy (freezing), curettage (scraping) and cautery (burning). These are not recommended for BCC’s on the face because the removed tissue is destroyed as a result of the treatment so complete removal cannot be assured.
Radiotherapy: Occasionally used for elderly patients with extensive lesions when major surgery may not be appropriate. Cosmetic results are worse than for those removed by excision and confirmation of tumour removal is not possible.
Photodynamic therapy (use of laser light and a chemical reaction to destroy cancer cells): effective for superficial BCCs.
Topical fluorouracil (cream or lotion containing anti-cancer drugs): useful in the management of multiple superficial basal cell carcinoma on the trunk and limbs.
Topical imiquimod (a substance containing a drug to improve the body’s natural response to disease): more effective for superficial than nodular tumours.
Prevention
If you have had one malignant skin tumour it is likely others will develop over the years. Prevention and early detection are important.
Examine your skin every 6-12 months for early warning signs, particularly those areas that are frequently exposed to the sun.
Wear protective clothing and wide brimmed hats when outdoors. These will protect the skin areas most at risk.
Wear 100%UV protective sunglasses
Avoid sunshine during the mid-day hours if possible
Use high factor sunscreen (SPF 15 or higher)
Images
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