Treatment

The treatment of eyelid cancer depends 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. In many cases, a team of doctors will work with the patient to determine the best treatment plan. This may include a dermatologist (a doctor who specializes in diseases and conditions of the skin), surgeon, radiation therapist, ophthalmologist (a medical doctor who specializes in diseases and function of the eye), and medical oncologist.

This section outlines treatments that are the standard of care (the best treatments available) for this specific type of cancer. Patients are also encouraged to consider clinical trials as a treatment option when making treatment plan decisions. A clinical trial is a research study to test a new treatment to prove it is safe, effective, and possibly better than standard treatment. Your doctor can help you review all treatment options. For more information, visit the Clinical Trials section.

Surgery

Different types of surgical procedures are used depending on the size of the cancer and where it is located.

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 a larger tumor, a tumor in hard-to-reach place, and for cancer that has recurred (come back) in the same place; however, it is increasingly becoming a preferred technique for removing an eyelid tumor. 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.

Extensive surgery may result in scarring and deformity of the eyelid, enucleation (removal of the eye), and/or may cause problems with tear drainage.

Radiation therapy

Radiation therapy is the use of high-energy x-rays or other particles to kill cancer cells. The most common type of radiation treatment is called external-beam radiation therapy, which is radiation given from a machine outside the body. This procedure 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.

Side effects from radiation therapy may include fatigue, mild skin reactions, upset stomach, and loose bowel movements. Most side effects go away soon after treatment is finished. 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 include over-the-counter eye drops, prescription eye drops such as cyclosporine ophthalmic (Restasis), and plugs that can be placed in the tear ducts. Talk with your ophthalmologist about how to help relieve 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 therapy 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.

Radiation optic neuropathy. Radiation optic neuropathy is radiation-induced optic nerve damage.

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.

Chemotherapy

Chemotherapy is the use of drugs to kill cancer cells. Topical chemotherapy, in which drugs are placed directly on the skin, may be used when an eyelid tumor cannot be removed by surgery.

The medications used to treat cancer are continually being evaluated. Talking with your doctor is often the best way to learn about the medications prescribed for you, their purpose, and their potential side effects or interactions with other medications. Learn more about your prescriptions through Cancer.Net’s Drug Information Resources, which provides links to searchable drug databases.

Advanced eyelid cancer

In rare cases, melanoma, squamous cell carcinoma, or sebaceous carcinoma may 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 or radiation therapy may be necessary. Immunotherapy (also called biologic therapy) is designed to boost the body's natural defenses to fight the cancer. It uses materials either made by the body or in a laboratory to bolster, target, or restore immune system function.

To learn about the terms used in this section, read the Cancer.Net Feature: Cancer Terms to Know: During Treatment.