Malignant Tumors of the Eye
An eyelid lesion is a pathological change in the tissue of the eyelid. There are many types of lesions, most of which are benign or harmless. However, some lesions may be malignant or cancerous. This section will deal with malignant tumors.
There are four main types of malignant tumors that can appear on your eyelids:
- Basal cell carcinoma
- Squamous cell carcinoma
- Sebaceous carcinoma
With the exception of sebaceous carcinoma, excessive exposure to the UV rays of sunlight is the most common risk factor for malignant tumors on your eyelids. As you grow older, the risk of malignant tumors increases. Caucasians are at greater risk for developing a malignant skin cancer on the eyelid than other races.
Basal Cell Carcinoma
The most common type of malignancy on the eye lid is a basal cell carcinoma. This type of tumor is a small nodule that often appears on the lower eyelid. Although basal cell carcinoma does not usually metastasize to other parts of the body, it can invade other parts of your eye. If you have a growth on your eyelid, it should not be ignored. Prompt surgical removal and biopsy is recommended if a growth is suspected to be a basal cell carcinoma.
Squamous Cell Carcinoma
Squamous cell carcinoma is a much more aggressive form of cancer that can occur on the eyelids. This type of carcinoma occurs more frequently on the upper eyelid and looks like a raised and scaly lesion that may also be ulcerated. Frequently, squamous cell carcinoma develops from a pre-cancerous lesion called actinic keratosis (AK). Prompt surgical removal and biopsy is necessary.
Actinic keratosis (AK) is a scaly or white patch that forms on the surface of your skin, usually in those areas exposed to sunlight. Although AKs are benign, they are also considered to be pre-cancerous lesions. Because they can lead to the more aggressive squamous cell carcinoma, we recommend that any AK on your eyelid be surgically removed and sent for a biopsy.
Another type of eyelid lesion is called a keratoacanthoma (KA), a raised tumor that may have a thick center. In the past, KAs were considered to be benign tumors. However, more recent studies have concluded that some KAs can also evolve into squamous cell carcinomas.
KAs are tumors that appear on parts of the body exposed to sunlight, most commonly on the face, ears, neck and top of the head. They are initially fast growing. After they stabilize, they may recede on their own. In addition to being unsightly, unless they are surgically removed and subjected to biopsy, there is no way to determine if there is an underlying carcinoma. For this reason, we also recommend that KAs be surgically removed and sent for biopsy.
Sebaceous carcinoma (SC) is an invasive and aggressive tumor that occurs in any of the body’s oil glands. However, 75 percent of cases are located in the oil glands near the eye. SC can often look like a chalazion or even chronic blepharitis. A sebaceous carcinoma is a small, painless, nodule usually located on the upper lid. Often, an SC may be yellow. SC can also cause eyelashes in the affected area to fall out.
SC is a form of skin cancer that can metastasize to other parts of the body. Since the symptoms of SC mimic benign conditions, diagnosis can be difficult. If you have had episodes of apparently recurrent chalazia or styes, or blepharitis that hasn’t responded to rigorous treatment, you should make your eye doctor aware of these facts, especially if you did not seek treatment for these conditions. Anyone with a family history of Muir-Torre syndrome, a rare disorder that includes certain types of skin cancer and colorectal cancer, should be especially conscious of chalazion-type growths on the eyelid and alert his or her eye doctor to this fact.
If you doctor suspects, SC a tissue biopsy will be needed, along with surgical removal of the tumor.
Melanoma on the eyelid is rare, representing approximately one percent of the cancerous lesions on eyelids. While only three percent of all skin cancers, including lesions on the eyelid, are melanomas, melanoma accounts for almost two out of three (2/3) deaths due to skin cancer. For this reason, particular caution must be paid to all eye lesions that are pigmented or colored.
Melanomas usually appear as a tan or brown growth or nodule on the eyelid. They are irregularly shaped growths that can also display changes in color. In some cases, a melanoma can be ulcerated and bleed.
How Are Tumors Detected?
The only way to definitively diagnose a cancerous tumor is through a biopsy. Following a comprehensive eye examination which will include a slit lamp examination, your eye doctor will recommend a surgical biopsy for any suspicious, pigmented tumor. Although this biopsy may be done before surgery, in most cases of eyelid tumors, the growth will be removed through surgical excision and then sent for a biopsy.
If the biopsy determines that the cancer is melanoma or sebaceous carcinoma, both of which can metastasize to other parts of the body, further diagnostic procedures may be required.
How Are Tumors Treated?
Surgical removal of an eyelid tumor is the most effective treatment for suspected cancerous growths. To completely remove the tumor, a “clean margin”, sufficient clearance around the tumor that is free from the cancer, is established. When indicated, a Moh's procedure will be performed, to ensure a clear margin.
Our board certified ophthalmologist who has also done a fellowship in oculoplastic surgery performs surgical removal of eyelid tumors and will reconstruct the area to achieve the best acceptable cosmetic and function result. He will review the appropriate treatment options with you.
During a surgical excision of an eyelid tumor, you will feel little or no discomfort. On the day of treatment, a staff member will welcome you. The staff will help you prepare for your surgery by putting eye drops in your eye. You will be given a gown to wear over your street clothes during your actual surgery.
You may be given a relaxing sedative along with local anesthetic. An injection will also be given around the eye for comfort. Usually self-dissolving stitches will be used to close the incision. In most cases, no eye patch is used.
Immediately after the surgery, you will rest in a comfortable reclining chair. Your family members may then join you in reviewing your follow-up care and schedule. You may be given medication or eyedrops to prevent infection. If a sedative is used, you will need a driver.
Your eye may appear to be slightly bruised and swollen following the surgery. However, this should not cause significant discomfort. Your surgeon will follow-up with you to monitor healing and check for signs of inflammation and infection.
Some potential complications from surgery include the risk of bleeding, infection and hematoma, which can usually be successfully treated. The benefit of preventing vision and life-threatening metastasis outweighs these risks.
Oculoplastic Specialist at Kadrmas Eye Care New England
Meet our oculoplastic surgeon who specializes in the treatment of eyelid diseases and disorders: