Types of Eyelid Cancers
Basal Cell Carcinoma
This is by far the most common type of cancer involving the eyelid. Nearly ninety percent of basal cell carcinomas occur on the lower lids. This is most likely secondary to the lower eyelids being exposed to the damaging ultraviolet light from the sun. In most cases it is characterized by a nodular shape with a waxy sheen. It may bleed slightly at times, form a scab, slough off, itch, and usually grows slowly. There are other types of basal cell carcinoma that do not have the classical appearance, have flat appearance and extend under the outer skin layer. Basal cell carcinomas are very common and do not metastasize. They can be cured with surgical removal. If not remove they can continue to grow and spread into other structures such as near the medial portion of the eyelid where it can grow into the lacrimal drainage system into the nose.
Squamous Cell Carcinoma
Squamous cell carcinomas of the eyelid occur only on an occasional basis. The lesion can have an appearance similar to a basal cell carcinoma but usually have a rougher and more excoriated appearance. Squamous cell carcinomas do have the ability to metastasize but if removed early usually do not do so.
Sebaceous Gland Carcinoma
Sebaceous gland carcinomas occur very rarely on the eyelid. They are often misdiagnosed which can delay their removal. Sebaceous gland carcinomas have a history of metastasizing and having a high mortality rate. This could be due to the delay in diagnosis but is also related to the aggressive nature of sebaceous gland carcinomas.
The reason for the delay in diagnosis for sebaceous gland carcinoma is that they can have an appearance of common diseases of the eyelid called a chalazion or hordeolum (stye). If you have a chalazion or hordeolum of the eyelid that will not go away with treatment or the eye doctor feels that it does not have the typical appearance or clinical course of one of these diseases, you should consider having the eye surgeon biopsy the lesion to make sure that it is not a sebaceous gland carcinoma.
Treatment of Eyelid Cancers
If you have a lesion on your eyelid that looks suspicious for a cancer, you should have it biopsied. If the biopsy shows that it is a cancer, then complete removal of the cancer is necessary. If the cancer involves the edge or margin of the eyelid or is near the margin of the eyelid, a wedge resection around the area of the cancer is most likely necessary. This requires cutting completely through the eyelid like cutting a piece of pie and making sure that they are clear margins around the area of the cancer. Many eye surgeons will have a frozen section performed on the tissue immediately to make sure that the cancer was completely removed before repairing the eyelid. If the area of tissue removal is not too large then a straight forward closure with sutures will provide an excellent cosmetic result in most cases. If the area is too large then a flap of tissue may have to be rotated over to complete the repair. If the area is still larger then skin grafts and eyelid tarsal replacement may be necessary.
If you see a lesion on your eyelids, make an appointment with your eye doctor and have it evaluated. The earlier a cancer is detected and removed results in a better outcome with an excellent cosmetic appearance.