Eyelid cancer is a general term for a cancer that occurs on or in the eyelid and is broadly categorized as an epithelial (outer surface) tumor. An eyelid tumor may be benign (noncancerous) or malignant (cancerous), and can begin from sebaceous (fat), sweat, and apocrine glands (a type of sweat gland). The most common types of cancer occurring on the eyelid are:
Basal cell carcinoma. Under the squamous cells (flat, scale-like cells) in the lower epidermis (outer layer of skin) are round cells known as basal cells. About 80% of skin cancers arise from this layer in skin, and they are directly related to exposure to the sun. Basal cell carcinoma is the most common type of eyelid cancer, usually appearing in the lower lid and occurring most often in individuals with fair or pale skin.
Sebaceous carcinoma. Mostly occurring in middle-age to older adults, sebaceous carcinoma is the second most common eyelid cancer. It may arise from meibomian glands (glands of the eyelids that discharge a fatty secretion that lubricates the eyelids) and, less frequently, glands of Zeis (sebaceous glands at the base of the eyelashes). Sebaceous carcinoma is an aggressive cancer that normally occurs on the upper eyelids and is associated with radiation exposure, Bowen's disease, and Muir-Torre syndrome. A large sebaceous carcinoma or a cancer that returns after treatment may require surgical removal of the eye.
Squamous cell carcinoma. The top layer of the epidermis is mostly made up of squamous cells. Approximately 10% to 30% of skin cancers begin in this layer and usually arise from sun exposure, but can also appear on skin that has been burned, damaged by chemicals, or exposed to x-rays. Squamous cell carcinoma is much less common than basal cell carcinoma, but it behaves more aggressively and can more easily spread to nearby tissues.
Melanoma. The deepest layer of the epidermis contains scattered cells called melanocytes, which produce the melanin that gives skin color. Melanoma starts in melanocytes, and it is the most serious of the three skin cancer types. Please see the Cancer.Net Guide to Melanoma for more information.
Eyelid cancer is rare, with only 19.6 cases reported per every 100,000 men and 13.3 cases per every 100,000 women in the United States each year. The most common eyelid malignancy, basal cell carcinoma, affects 16.9 men and 12.4 women per every 100,000 people each year. Estimates of a cure rate of basal cell carcinoma reach as high as 95%, although this depends on several factors, including the extent of the disease when diagnosed.
Cancer statistics should be interpreted with caution. These estimates are based on data from thousands of cases of this type of cancer in the United States, but the actual risk for a particular individual may differ. It is not possible to tell a person how long he or she will live with eyelid cancer.
A risk factor is anything that increases a person's chance of developing cancer. Some risk factors can be controlled, such as smoking, and some cannot be controlled, such as age and family history. Although risk factors can influence the development of cancer, most do not directly cause cancer. Some people with several risk factors never develop the disease, while others with no known risk factors do. However, knowing your risk factors and communicating with your doctor can help guide you in making more informed lifestyle and health-care choices.
The following factors can raise a person's risk of developing eyelid cancer:
Exposure to UV radiation. Sunlight includes both ultraviolet A (UVA) and ultraviolet B (UVB) radiation. UVB radiation produces sunburn and plays a role in the development of basal cell carcinoma, squamous cell carcinoma, and melanoma. UVA radiation penetrates the skin more deeply, causing photoaging or wrinkling. The role of UVA radiation in the development of non-melanoma eyelid cancer is suspected, but not certain. People who live in areas with year-round, bright sunlight have a higher risk of developing an eyelid cancer, as do those who spend excess time outside or on a tanning bed (which produces mostly UVA radiation).
Fair skin. Less melanin (pigment) in skin offers less protection against UV radiation. People with light hair and light-colored eyes who have skin that doesn't tan, but instead freckles or burns easily, are more likely to develop eyelid cancer.
Gender. Rates of skin cancer in white men have increased in recent years.
Age. Most basal and squamous cell cancers appear after age 50.
A history of sunburns or fragile skin. Skin that has been burned, sunburned, or injured from disease is at higher risk for eyelid cancer. Squamous cell and basal cell cancers more often occur with repeated, long-term exposure to the sun, while melanoma more often occurs with short-term intense exposure to sun.
Individual history. People with weakened immune systems or those who use certain medications are at higher risk for developing squamous cell and basal cell cancers. People with rare, predisposing genetic conditions such as xeroderma pigmentosum, nevoid basal cell carcinoma syndrome, or albinism are at much higher risk for eyelid cancer.
Previous skin cancer. People who have had any form of skin cancer are at higher risk for developing another skin cancer. For instance, about 35% to 50% of people diagnosed with one basal cell cancer will develop a new cancer within five years.
Precancerous skin conditions. Two types of lesions, known as actinic keratoses (characterized by rough, red or brown, scaly patches on the skin), or Bowen's disease (characterized by a bright red or pink, scaly patches located on previously or presently sun-exposed skin) can be related to the development of squamous cell cancer in some people. Bowen's disease in areas not exposed to the sun may be related to arsenic exposure.
People with eyelid cancer may experience the symptoms described below. Sometimes people with eyelid cancer do not show any of these symptoms. Or, these symptoms may be caused by a medical condition that is not cancer. If you are concerned about a symptom on this list, please talk with your doctor, specifically an oncologist (a doctor who specializes in cancer) or ophthalmologist (a doctor who specializes in the treatment of the eye).
A change in appearance of the eyelid skin
Swelling of the eyelid
Thickening of the eyelid
Chronic infection of the eyelid
An ulceration (area where skin is broken) on the eyelid that does not heal
Doctors use many tests to diagnose cancer and determine if it has metastasized (spread). Some tests may also determine which treatment may be the most effective. Your doctor may consider these factors when choosing a diagnostic test:
Age and medical condition
The type of cancer and its risk for metastasis
Severity of symptoms
Previous test results
The following tests may be used to diagnose eyelid cancer:
Biopsy. Because basal cell and squamous cell cancers rarely spread to distant parts of the body, a biopsy is often the only test needed to determine the extent of cancer. A biopsy removes a small amount of tissue for examination under a microscope. Other tests can suggest that cancer is present, but only a biopsy can make a definite diagnosis. The type of biopsy performed will depend on the location of the cancer. During this procedure, performed under local or general anesthetic, the doctor removes the suspicious tissue using techniques that test the thickness of the cancer and its margins (healthy tissue around the lesion). The tissue sample is sent to a pathologist (a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease) who determines if the sample contains cancer and, if so, which type. The amount of normal tissue removed around the cancer depends on its thickness. Further treatment beyond the biopsy may not be necessary if the entire growth is removed. If cancer is present at the edges of the tissue taken for the biopsy, additional treatment (for example, surgery, radiation therapy, or cryotherapy) will usually be necessary.
Computed tomography (CT or CAT) scan. A CT scan creates a three-dimensional picture of the inside of the body with an x-ray machine. A computer then combines these images into a detailed, cross-sectional view that shows any abnormalities or tumors. Sometimes, a contrast medium (a special dye) is injected into a patient's vein to provide better detail.
Magnetic resonance imaging (MRI). An MRI uses magnetic fields, not x-rays, to produce detailed images of the body.
Positron emission tomography (PET) scan. In a PET scan, radioactive sugar molecules are injected into the body. Cancer cells absorb sugar more quickly than normal cells, so they light up on the PET scan. PET scans are often used to complement information gathered from CT scan, MRI, and physical examination.
Ultrasound. An ultrasound uses sound waves to create a picture of the internal organs. This may be useful to determine if cancer has spread.
A doctor will determine the extent, or stage, of the cancer's progress in order to plan treatment. The stage depends on how thick or large the tumor is and whether there is evidence that the cancer may have spread. On rare occasions, a patient's lymph nodes may be removed to determine if the cancer has metastasized. The doctor may perform other tests, including a blood sample, MRI, and diagnostic scans of the liver, bones, and brain.
Staging is a way of describing a cancer, such as where it is located, if or where it has spread, and if it is affecting the functions of other organs in the body. Doctors use diagnostic tests to determine the cancer's stage, so staging may not be complete until all tests are finished. Knowing the stage helps the doctor to decide what kind of treatment is best and can help predict a patient's prognosis (chance of recovery). There are different stage descriptions for different types of cancers.
One tool that doctors use to describe the stage is the TNM system. This system uses three criteria to judge the stage of the cancer: the tumor itself, the lymph nodes around the tumor, and if the tumor has spread to the rest of the body. The results are combined to determine the stage of cancer for each person. There are five stages: stage 0 (zero) and stages I through IV (one through four). The stage provides a common way of describing the cancer so doctors can work together to plan the best treatments.
TNM is an abbreviation for tumor (T), node (N), and metastasis (M). Doctors look at these three factors to determine the stage of cancer:
How large is the primary tumor and where is it located? (Tumor, T)
Has the tumor spread to the lymph nodes? (Node, N)
Has the cancer metastasized to other parts of the body? (Metastasis, M)
Tumor. Using the TNM system, the "T" plus a letter and/or number (0 to 4) is used to describe the stage of eyelid cancer. Some stages are also divided into smaller groups that help describe a patient's condition in more detail. This helps the doctor develop the best treatment plan for each patient. Specific tumor stage information is listed below.
TX: The primary tumor cannot be assessed.
T0 (T plus zero): There is no tumor.
Tis: Refers to carcinoma in situ. This means that the tumor remains in a pre-invasive state, and its spread, if any, is very limited.
T1: The tumor is 5 millimeters (mm) or smaller in diameter, or is not invading the tarsal plate (the supporting structure of the eyelid).
T2: The tumor is larger than 5 mm, but not more than 10 mm in greatest diameter, or has invaded the tarsal plate.
T3: The tumor is larger than 10mm in greatest diameter, or has spread into the full thickness of the eyelid.
T4: The tumor has invaded adjacent structures such as the bulbar conjunctiva, sclera and globe, soft tissues of the orbit, perineural space, bone and periosteum of the orbit, nasal cavity and paranasal sinuses, or central nervous system.
Node. The "N" in the TNM staging system stands for lymph nodes, the tiny, bean-shaped organs that help fight infection. Lymph nodes near the eyelid are called regional lymph nodes. Lymph nodes in other parts of the body are called distant lymph nodes.
NX: The regional lymph nodes cannot be assessed.
N0 (N plus zero): There is no regional lymph node metastasis.
N1: There is regional lymph node metastasis.
Distant metastasis. The "M" in the TNM system indicates whether the cancer has spread from the eyelid to other parts of the body.
MX: Distant metastasis cannot be assessed.
M0 (M plus zero): There is no distant metastasis.
M1: There is metastasis to other parts of the body.
Histopathology and grading
Histology describes how closely the cancer cells resemble normal tissue under a microscope. A tumor's grade is described using the letter G and a number.
GX: The tumor grade cannot be identified.
G1: Describes cells that look more like normal tissue cells (well differentiated).
G2: Describes cells that look somewhat different from normal cells (moderately differentiated).
G3: Describes tumor cells that look very much unlike normal cells (poorly differentiated).
G4: The tumor cells barely resemble normal cells (undifferentiated).
Used with permission of the American Joint Committee on Cancer (AJCC), Chicago, Illinois. The original source for this material is the AJCC Cancer Staging Manual, Sixth Edition (2002) published by Springer-Verlag New York, www.springer-ny.com.
The treatment of eyelid cancer varies depending on the type of cancer and the tumor's location. Doctors may use a combination of treatments in order to effectively remove the cancer and reduce the chance of it spreading. A team of specialists may help plan appropriate treatment. They may include a dermatologist (a doctor who specializes in diseases and conditions of the skin), surgeon, radiation therapist, ophthalmologist, and medical oncologist.
Surgery
Different types of surgical procedures are used depending on the size of the cancer and where it is located. Extensive surgery may result in scarring and deformity of the eyelid, enucleation (removal of the eye), and/or may cause problems with tear drainage.
Biopsy. A surgical biopsy may remove part of the tumor (incisional) or the entire tumor (excisional). If the tumor is found to be cancerous, and the surgeon has removed a sufficient margin of healthy tissue along with the tumor, the excisional biopsy may be the only treatment needed.
Mohs' surgery. This technique involves removing the visible tumor, in addition to small fragments of the edge of where the tumor existed. Each small fragment is examined under a microscope until all cancer is removed. This procedure is most often used for larger tumors, those in hard-to-reach places, and for cancers that have recurred (come back) in the same place; however, it is increasingly becoming a preferred technique for removing all types of eyelid tumors. Following Mohs' surgery, reconstruction may be necessary by an ophthalmologist or plastic surgeon trained in ocular (eye) reconstructive procedures.
Cryosurgery. Cryosurgery, also called cryotherapy or cryoablation, uses liquid nitrogen to freeze and kill cells. The skin will later blister and slough (shed) off. This procedure will sometimes leave a white scar. More than one freezing may be needed.
Radiation therapy
This procedure, which uses high-energy x-rays or other particles to kill cancer cells, may be used for a cancer that is hard to treat with surgery. Several treatments may be needed. The treatment may produce a rash, make the skin dry, or change the color of the skin.
External-beam radiation therapy delivers radiation from a machine outside the body directly to the tumor and may be given as a primary treatment, after enucleation, or as a palliative treatment (care given to improve quality of life by treating symptoms and side effects of the cancer or its treatment).
Radiation therapy may result in a variety of side effects, so it is important to talk with your ophthalmologist or oncologist about what to expect. The extent of side effects depends on the type and dose of radiation therapy the patient receives, where the tumor is located, and the patient's general health. Some side effects (listed below) may not show up right away.
Cataracts. Cataracts are very common. A cataract occurs when the lens of the eye becomes cloudy. People with cataracts may have cloudy or foggy vision, have trouble seeing at night, or have problems with glare from the sun or bright lights. If the cataract is causing major problems with a person's eyesight, it can be surgically removed.
Loss of eyelashes and/or a dry eye. Loss of eyelashes and/or a dry eye can occur with radiation therapy. Some treatment options for this condition includes over the counter eye drops, prescription eye drops such as Restasis (cyclosporine ophthalmic), and plugs that can be placed in the tear ducts. Talk with your ophthalmologist about how to manage these side effects.
Change in lid position. After radiation therapy and/or surgery, the eyelid may roll inward (entropion) or sag outward (ectroption). Either condition may affect eye health and can be repaired with surgery.
Other common side effects. Other common side effects from radiation treatment include red eye, tearing, and sensitivity to light.
The following side effects are much less common and can cause a loss of vision:
Radiation retinopathy. Radiation retinopathy is the development of abnormal blood vessels in the retina, which is the thin-layered structure that lines the eyeball.
Neovascular glaucoma. Neovascular glaucoma is a painful condition that involves new blood vessels developing and blocking the regular release of fluid from the eye.
If there is significant damage to the eye from radiation therapy, the eye may need to be removed.
Advanced eyelid cancer
In rare cases, melanoma, squamous cell carcinoma, or sebaceous carcinoma can spread to other parts of the body.
If the cancer has spread to nearby areas, such as the tumor invading the sinuses or brain, radical surgical resection (extensive surgery) may be an option.
Surgery alone is not effective in treating eyelid cancer that has metastasized to distant parts of the body. To control this distant spread, chemotherapy, immunotherapy (also called biologic therapy, designed to boost the body's immune system by using materials either made by the body or in a laboratory to bolster, target, or restore immune function), or radiation therapy may be necessary.
Doctors and scientists are always looking for better ways to treat patients with eyelid cancer. A clinical trial is a way to test a new treatment in order to prove that it is safe, effective, and possibly better than a standard treatment. Patients who participate in clinical trials are among the first to receive new treatments before they are widely available. However, there is no guarantee that the new treatment will be safe, effective, or better than a standard treatment.
Patients decide to participate in clinical trials for many reasons. For some patients, a clinical trial is the best treatment option available. Because standard treatments are not perfect, patients are often willing to face the added uncertainty of a clinical trial in the hope of a better result. Other patients volunteer for clinical trials because they know that finding new drugs and other therapies is the only way to make progress in treating eyelid cancer. Even if they do not benefit directly from the clinical trial, their participation may benefit future patients with eyelid cancer.
To join a clinical trial, patients must complete a learning process known as informed consent. During informed consent, the doctor should list all of the patient's options, so the person understands how the new treatment differs from the standard treatment. The doctor must also list all of the risks of the new treatment, which may or may not be different from the risks of standard treatment. Finally, the doctor must explain what will be required of each patient in order to participate in the clinical trial, including the number of doctor visits, tests, and the schedule of treatment. Learn more about clinical trials, including patient safety, phases of a clinical trial, deciding to participate in a clinical trial, questions to ask the research team, and links to find cancer clinical trials.
Cancer and cancer treatment can cause a variety of side effects; some are easily controlled and others require specialized care. Below are some of the side effects that are more common to eyelid cancer and its treatments. For more detailed information on managing these and other side effects of cancer and cancer treatment, visit Cancer.Net: Managing Side Effects.
Infection. An infection occurs when harmful bacteria, viruses, or fungi (such as yeast) invade the body and the immune system is not able to destroy them quickly enough. Patients with cancer are more likely to develop infections because both cancer and cancer treatments (particularly chemotherapy and radiation therapy to the bones or extensive areas of the body) can weaken the immune system. Symptoms of infection include fever (temperature of 100.5°F or higher); chills or sweating; sore throat or sores in the mouth; abdominal pain; pain or burning when urinating or frequent urination; diarrhea or sores around the anus; cough or breathlessness; redness, swelling, or pain, particularly around a cut or wound; and unusual vaginal discharge or itching.
Pain. Depending on the stage of disease, 30% to 75% of all patients experience pain from cancer. About 85% to 95% of cancer pain can be treated successfully. Pain can make other aspects of cancer seem worse, such as fatigue (tiredness), weakness, sleep disturbance, and confusion. Pain can come from the tumor itself or may be a result of cancer treatment. Pain from a tumor can be a result of the tumor growing and spreading to the bones or other organs and putting pressure on and damaging nerves. Pain from surgery is normal and may persist for months or years. Pain may develop after radiation therapy and go away on its own. It can also develop months or years after treatment, especially after radiation therapy to the chest, breast, or spinal cord. Certain medications may cause pain along with numbness in the fingers and toes. Usually this pain goes away when treatment is finished, but sometimes the damage can be permanent.
After treatment for eyelid cancer ends, talk with your doctor about developing a follow-up care plan. This plan may include regular physical examinations and/or medical tests to monitor your recovery for the coming months and years. Most patients treated for eyelid cancer are successfully treated with a good cosmetic result.
Most people do not have any long-term effects because of their cancer. However, people treated for eyelid cancer need close observation by their ophthalmologist and oncologist to ensure that the tumor does not recur or spread to other organ systems. The doctor will most likely make recommendations as to the frequency of necessary follow-up care and testing. In some circumstances, your doctor may require routine blood and imaging testing to ensure that there is no recurrence or spread of the tumor.
Some side effects may occur months or years after treatment and therefore continued follow-up care by your doctor is essential.
Many patients with eyelid cancer require reconstructive surgery. Reconstructive surgery differs from cosmetic surgery, in that it is generally performed to improve function, but may also be done to approximate a normal appearance, whereas cosmetic surgery is performed on normal structures for the purpose of appearance. A surgeon may use skin grafts in order to completely reconstruct the eyelid and give patients a normal appearance.
Research involving more advanced diagnostic procedures and treatment for eyelid cancer is ongoing. The following advancements may still be under investigation in clinical trials and may not be approved or available at this current time. Always discuss all diagnostic and treatment options with your doctor.
A number of clinical trials for eyelid cancer are currently underway. There have been significant advances in surgical procedures to look for spread of a tumor from the periocular area to regional lymph nodes. Sentinel lymph node biopsy is one such technique. You may want to ask your doctor whether such a procedure is available.
There have been numerous advances in the management of skin melanoma with a focus on vaccines that may be helpful in preventing future spread. New therapeutic combinations of chemotherapy for those with advanced metastatic disease are also under investigation.
Regular communication with your doctor is important in making informed decisions about your health care. Consider asking the following questions of your doctor:
General questions:
What type of eyelid cancer has been diagnosed?
What does my diagnosis mean?
Do I need treatment right away?
What treatment do you recommend?
What is the goal of this treatment?
What clinical trials are open to me?
For people who need surgery:
What type of surgery is recommended? Why/
What are the side effects of this surgery?
Will I need to stay in the hospital for this surgery? For how long?
Will I my vision be affected? For how long?
Will I need reconstructive surgery?
For people who need radiation treatment:
What kind of radiation therapy is recommended?
What does the preparation for this treatment involve?
What is the likelihood of my eye being damaged?
What other short-term and long-term side effects can I expect from this treatment?
What can be done to relieve side effects?
For people who need an eye removed:
How do I adjust to using one eye?
How long will it take me to recover?
How soon can I get a prosthesis (artificial eye)?
When do I get a permanent prosthesis?
How do I care for my prosthesis?
After treatment:
What are the chances that the cancer will return?
What follow-up tests do I need, and how often do I need them?
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