Cancers of the eyelid


The term cancer implies uncontrolled unregulated growth. Like elsewhere in the body, small clusters of cells within the eyelid can start to grow and proliferate uncontrollably leading to a malignant tumour. Eyelid cancer work forms a significant proportion of work for most oculoplastic surgeons. The management of most eyelid cancers involves surgery to remove the cancer followed by reconstruction of the region to give as good a functional and cosmetic result as possible for the patient.

 Basal Cell Carcinoma
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Basal cell carcinoma (rodent ulcer) is the commonest cancer of the eyelid. The classic presentation of a BCC is a hard nodule with a pearly edge, often with dilated blood vessels on its surface (telangiectasia) and central ulcer formation as the BCC enlarges. It arises from the skin of the eyelid itself and most commonly affects the lower eyelid. How likely it is to develop in a person is related to the fairness of that person’s skin and the amount of sun exposure that person receives. Although it does not spread to distant sites (metastasis), it can, if left untreated, continue to enlarge and invade surrounding structures. BCCs if ignored will eventually invade the surrounding structures.
A typical BCC of the lower eyelid. Note the rounded edges to the lump and a central ulcer which intermittently bleeds.
On the whole, surgery for larger tumours is likely to be more extensive. Although, the best management of most eyelid cancers, involves their surgical removal, some patients with BCC may be treated with other methods e.g. radiotherapy or cryotherapy.

Less commonly, other types of cancers may develop around the eye e.g. malignant melanoma, squamous cell carcinoma, sebaceous gland carcinoma. They are by far much less common than BCCs, but their management on the whole requires more radical treatment than BCCs, at times involving joint care with other types of doctors e.g. oncologists, maxillofacial surgeons, general plastic surgeons, due to their ability to spread to distant sites. BCCs differ from most cancers in that they rarely spread to distant sites.

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Click here to see slides of cases of eyelid cancers and their treatment
(Warning: Some of the pictures are graphic and may cause distress)