Eyelid Cancer: Stages and Grades

Approved by the Cancer.Net Editorial Board, 08/2015

ON THIS PAGE: You will learn about how doctors describe a cancer’s growth or spread. This is called the stage. This section also covers grading, which describes the composition of cells. To see other pages, use the menu on the side of your screen.

Staging is a way of describing where the cancer is located, if or where it has spread, and whether it is affecting other parts of the body. Doctors use diagnostic tests to find out 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, which is the chance of recovery. There are different stage descriptions for different types of cancer.

Along with staging, the type of tumor is important for a patient’s prognosis. For example, a basal cell carcinoma has a more favorable prognosis than a Merkel cell carcinoma. Staging for eyelid carcinoma includes the following types of tumors:

  • Melanoma

  • Basal cell carcinoma

  • Squamous cell carcinoma

  • Mucoepidermoid carcinoma

  • Sebaceous carcinoma

  • Primary eccrine adenocarcinoma

  • Primary apocrine adenocarcinoma

  • Adenoid cystic carcinoma

  • Merkel cell carcinoma

Staging of melanoma of the eyelid

For eyelid melanoma staging, read the main melanoma staging section found on this website.

Staging of non-melanoma eyelid carcinoma

One tool that doctors use to describe the stage is the TNM system. Doctors use the results from diagnostic tests and scans to answer these questions:

  • Tumor (T): How large is the primary tumor? Where is it located?

  • Node (N): Has the tumor spread to the lymph nodes? If so, where and how many?  

  • Metastasis (M): Has the cancer metastasized to other parts of the body? If so, where and how much?

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.

Here are more details on each part of the TNM system for eyelid cancer:

Tumor (T)

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 the tumor in even 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 evaluated.

T0 (T plus zero): There is no tumor.

Tis: This refers to carcinoma in situ, which is a tumor that has the potential to invade nearby tissues but hasn’t yet.

T1: The tumor is 5 millimeters (mm) or smaller in diameter, or it is not invading the tarsal plate, the supporting structure of the eyelid.

T2a: The tumor is larger than 5 mm but not more than 10 mm in greatest diameter, or it has invaded the tarsal plate.

T2b: The tumor is larger than 10 mm but not more than 20 mm in greatest diameter, or it has spread into the full thickness of the eyelid.

T3a: The tumor is larger than 20 mm in greatest diameter or has spread to nearby parts of the eye.

T3b: The tumor has spread to a point where complete removal of the tumor requires removing the eye and/or adjacent structures.

T4: The tumor cannot be removed with surgery because it has spread extensively.

Node (N)

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 evaluated.

N0 (N plus zero): There is no regional lymph node metastasis.

N1: There is regional lymph node metastasis.

Metastasis (M)

The “M” in the TNM system indicates whether the cancer has spread from the eyelid to other parts of the body, called distant metastasis.

MX: Distant metastasis cannot be evaluated.

M0 (M plus zero): There is no distant metastasis.

M1: There is metastasis to other parts of the body.

Grade (G)

Doctors also describe this type of cancer by its grade (G), which describes how much cancer cells look like healthy cells when viewed under a microscope. The doctor compares the cancerous tissue with healthy tissue. Healthy tissue usually contains many different types of cells grouped together.

If the cancer looks similar to healthy tissue and contains different cell groupings, it is called differentiated or a low-grade tumor. If the cancerous tissue looks very different from healthy tissue, it is called poorly differentiated or a high-grade tumor. The cancer’s grade may help the doctor predict how quickly the cancer will spread. In general, the lower the tumor’s grade, the better the prognosis.

GX: The tumor grade cannot be identified.

G1: Describes cells that look more like healthy tissue cells (well differentiated).

G2: Describes cells that look somewhat different from healthy cells (moderately differentiated).

G3: Describes tumor cells that look very much unlike healthy cells (poorly differentiated).

G4: The tumor cells barely resemble healthy cells (undifferentiated). 

Cancer stage grouping

Doctors assign the stage of the cancer by combining the T, N, M, and G classifications.

Stage 0: This is carcinoma in situ, meaning the tumor has the potential to be an invasive cancer, but it hasn’t become one yet (Tis, N0, M0).

Stage IA: The tumor is 5 mm or smaller in diameter or has not invaded the tarsal plate (the supporting structure of the eyelid), and the tumor has not spread to the regional lymph nodes or to other areas in the body (T1, N0, M0).

Stage IB: The tumor is larger than 5 mm but not more than 10 mm in greatest diameter, or it has invaded the tarsal plate. The tumor has not spread to the regional lymph nodes or to other areas in the body (T2a, N0, M0).

Stage IC: The tumor is between 10 mm and 20 mm in greatest diameter or has spread into the full thickness of the eyelid, but it has not spread to the regional lymph nodes or to other areas in the body (T2b, N0, M0).

Stage II: The tumor is larger than 20 mm in greatest diameter or has spread to nearby parts of the eye, but it has not spread to the regional lymph nodes or to other areas of the body. (T3a, N0, M0).

Stage IIIA: The tumor is large enough or has spread enough so that the surgeon will need to remove the eye and nearby structures to get rid of the tumor, but it has not spread to the regional lymph nodes or to other areas of the body (T3b, N0, M0).

Stage IIIB: The tumor is of any size and has spread to the regional lymph nodes, but not to other areas of the body (any T, N1, M0).

Stage IIIC: The tumor has spread outside of the eye, with or without spread to the regional lymph nodes, and cannot be surgically removed due to extensive invasion in structures near the eye. The tumor has not spread to distant parts of the body (T4, any N, M0).

Stage IV: A tumor of any size has spread outside of the eye to distant areas of the body (any T, any N, M1).

Recurrent: Recurrent cancer is cancer that has come back after treatment. It may return in the eye or another part of the body. If the cancer does return, there will be another round of tests to learn about the extent of the recurrence. These tests and scans are often similar to those done at the time of the original diagnosis.

Used with permission of the AJCC, Chicago, Illinois. The original source for this material is the AJCC Cancer Staging Manual, Seventh Edition, published by Springer-Verlag New York, www.cancerstaging.org. 

Information about the cancer’s stage and grade will help the doctor recommend a specific treatment plan. The next section in this guide is Treatment Options. Or, use the menu on the side of your screen to choose another section to continue reading this guide.