Eyelid cancer is a general term for a cancer that occurs on or in the eyelid and is broadly categorized as an epithelial (outer surface) tumor. An eyelid tumor may be benign (noncancerous) or malignant (cancerous, meaning it can spread to other places in the body). A tumor is a mass of tissue created by cells that grow abnormally and without control, and eyelid tumors can begin from sebaceous (fat), sweat, and apocrine glands (a type of sweat gland). The most common types of cancer occurring on the eyelid are:
Basal cell carcinoma. Under the squamous cells (flat, scale-like cells) in the lower epidermis (outer layer of skin) are round cells known as basal cells. About 80% of skin cancers arise from this layer in skin, and they are directly related to exposure to the sun. Basal cell carcinoma is the most common type of eyelid cancer, usually appearing in the lower lid and occurring most often in individuals with fair or pale skin.
Sebaceous carcinoma. Mostly occurring in middle-age to older adults, sebaceous carcinoma is the second most common eyelid cancer. It may start from meibomian glands (glands of the eyelids that discharge a fatty secretion that lubricates the eyelids) and, less frequently, glands of Zeis (sebaceous glands at the base of the eyelashes). Sebaceous carcinoma is an aggressive cancer that normally occurs on the upper eyelid and is associated with radiation exposure, Bowen’s disease, and Muir-Torre syndrome. A large sebaceous carcinoma, or one that returns after treatment, may require surgical removal of the eye.
Squamous cell carcinoma. The top layer of the epidermis is mostly made up of squamous cells. Approximately 10% to 30% of skin cancers begin in this layer and usually arise from sun exposure, but can also appear on skin that has been burned, damaged by chemicals, or exposed to x-rays. Squamous cell carcinoma is much less common than basal cell carcinoma, but it behaves more aggressively and can more easily spread to nearby tissues.
Melanoma. The deepest layer of the epidermis contains scattered cells called melanocytes, which produce the melanin that gives skin color. Melanoma starts in melanocytes, and it is the most serious of the three skin cancer types. Please see the Cancer.Net Guide to Melanoma for more information.
Statistics
Eyelid cancer is rare, with an average of 19.6 cases reported per every 100,000 men and 13.3 cases per every 100,000 women in the United States each year. The most common eyelid cancer, basal cell carcinoma, affects 16.9 men and 12.4 women per every 100,000 people each year. Estimates of a cure rate of basal cell carcinoma reach as high as 95%, although this depends on several factors, including the extent of the disease when diagnosed.
Cancer statistics should be interpreted with caution. These estimates are based on data from thousands of cases of this type of cancer in the United States, but the actual risk for a particular individual may differ. It is not possible to tell a person how long he or she will live with eyelid cancer.
A risk factor is anything that increases a person’s chance of developing cancer. Some risk factors can be controlled, such as smoking, and some cannot be controlled, such as age and family history. Although risk factors can influence the development of cancer, most do not directly cause cancer. Some people with several risk factors never develop cancer, while others with no known risk factors do. However, knowing your risk factors and communicating them to your doctor may help you make more informed lifestyle and health-care choices.
The following factors can raise a person's risk of developing eyelid cancer:
Exposure to UV radiation. Sunlight includes both ultraviolet A (UVA) and ultraviolet B (UVB) radiation. UVB radiation produces sunburn and plays a role in the development of basal cell carcinoma, squamous cell carcinoma, and melanoma. UVA radiation penetrates the skin more deeply, causing photoaging or wrinkling. The role of UVA radiation in the development of non-melanoma eyelid cancer is suspected, but not certain. People who live in areas with year-round, bright sunlight have a higher risk of developing an eyelid cancer, as do those who spend significant time outside or on a tanning bed (which produces mostly UVA radiation).
Fair skin. Less melanin (pigment) in skin offers less protection against UV radiation. People with light hair and light-colored eyes who have skin that doesn’t tan, but instead freckles or burns easily, are more likely to develop eyelid cancer.
Gender. Rates of skin cancer in white men have increased in recent years.
Age. Most basal and squamous cell cancers appear after age 50.
A history of sunburns or fragile skin. Skin that has been burned, sunburned, or injured from disease is at higher risk for eyelid cancer. Squamous cell and basal cell cancers more often occur with repeated, long-term exposure to the sun, while melanoma more often occurs with short-term intense exposure to sun.
Individual history. People with weakened immune systems or those who use certain medications are at higher risk for developing squamous cell and basal cell cancers. People with rare, predisposing genetic conditions such as xeroderma pigmentosum, nevoid basal cell carcinoma syndrome, or albinism are at much higher risk for eyelid cancer.
Previous skin cancer. People who have had any form of skin cancer are at higher risk for developing another skin cancer. For instance, about 35% to 50% of people diagnosed with one basal cell cancer will develop a new cancer within five years.
Precancerous skin conditions. Two types of lesions, known as actinic keratoses (characterized by rough, red or brown, scaly patches on the skin), or Bowen's disease (characterized by a bright red or pink, scaly patches located on previously or presently sun-exposed skin) may be related to the development of squamous cell cancer in some people. Bowen's disease in areas not exposed to the sun may be related to arsenic exposure.
People with eyelid cancer may experience the symptoms described below. Sometimes people with eyelid cancer do not show any of these symptoms. Or, these symptoms may be caused by a medical condition that is not cancer. If you are concerned about a symptom on this list, please talk with your doctor.
A change in appearance of the eyelid skin
Swelling of the eyelid
Thickening of the eyelid
Chronic infection of the eyelid
An ulceration (area where skin is broken) on the eyelid that does not heal
Doctors use many tests to diagnose cancer and determine if it has metastasized (spread). Some tests may also determine which treatments may be the most effective. For most types of cancer, a biopsy is the only way to make a definitive diagnosis of cancer. If a biopsy is not possible, the doctor may suggest other tests that will help make a diagnosis. Imaging tests may be used to find out whether the cancer has metastasized. Your doctor may consider these factors when choosing a diagnostic test:
Age and medical condition
The type of cancer suspected
Severity of symptoms
Previous test results
In addition to a physical examination, the following tests may be used to diagnose eyelid cancer:
Biopsy. Because basal cell and squamous cell cancers rarely spread to other parts of the body, a biopsy is often the only test needed to determine the extent of cancer. A biopsy removes a small amount of tissue for examination under a microscope. Other tests can suggest that cancer is present, but only a biopsy can make a definite diagnosis. The type of biopsy performed will depend on the location of the cancer. During this procedure, performed under local (numbing) or general anesthetic, the doctor removes the suspicious tissue using techniques that test the thickness of the cancer and its margins (healthy tissue around the lesion). The tissue sample is sent to a pathologist (a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease) who determines if the sample contains cancer and, if so, which type. The amount of normal tissue removed around the cancer depends on its thickness. Further treatment beyond the biopsy may not be necessary if the entire growth is removed. If cancer is present at the edges of the tissue taken for the biopsy, additional treatment (for example, surgery, radiation therapy, or cryotherapy) will usually be necessary.
Computed tomography (CT or CAT) scan. A CT scan creates a three-dimensional picture of the inside of the body with an x-ray machine. A computer then combines these images into a detailed, cross-sectional view that shows any abnormalities or tumors. Sometimes, a contrast medium (a special dye) is injected into a patient’s vein to provide better detail.
Magnetic resonance imaging (MRI). An MRI uses magnetic fields, not x-rays, to produce detailed images of the body. A contrast medium (a special dye) may be injected into a patient’s vein to create a clearer picture.
Positron emission tomography (PET) scan. A PET scan is a way to create pictures of organs and tissues inside the body. A small amount of a radioactive substance is injected into a patient’s body and absorbed by the organs or tissues being studied. This substance gives off energy that is detected by a scanner, which produces the images.
Ultrasound. An ultrasound uses sound waves to create a picture of the internal organs.
A doctor will determine the extent, or stage, of the cancer's progress in order to plan treatment. The stage depends on how thick or large the tumor is and whether there is evidence that the cancer may have spread. Occasionally, a patient’s lymph nodes may be removed to determine if the cancer has metastasized. The doctor may perform other tests, including a blood sample, MRI, and diagnostic scans of the liver, bones, and brain.
Staging is a way of describing a cancer, such as where it is located, if or where it has spread, and if it is affecting the functions of other organs in the body. Doctors use diagnostic tests to determine 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 (chance of recovery). There are different stage descriptions for different types of cancer.
One tool that doctors use to describe the stage is the TNM system. This system uses three criteria to judge the stage of the cancer: the tumor itself, the lymph nodes around the tumor, and if the tumor has spread to other parts of the body. 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.
TNM is an abbreviation for tumor (T), node (N), and metastasis (M). Doctors look at these three factors to determine the stage of cancer:
How large is the primary tumor and where is it located? (Tumor, T)
Has the tumor spread to the lymph nodes? (Node, N)
Has the cancer metastasized to other parts of the body? (Metastasis, M)
Tumor. 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: Refers to carcinoma in situ. This means that the tumor remains in a very early, pre-invasive state, and its spread, if any, is very limited.
T1: The tumor is 5 millimeters (mm) or smaller in diameter, or is not invading the tarsal plate (the supporting structure of the eyelid).
T2: The tumor is larger than 5 mm, but not more than 10 mm in greatest diameter, or has invaded the tarsal plate.
T3: The tumor is larger than 10mm in greatest diameter, or has spread into the full thickness of the eyelid.
T4: The tumor has invaded adjacent structures, such as the bulbar conjunctiva, sclera and globe, soft tissues of the orbit, perineural space, bone and periosteum of the orbit, nasal cavity and paranasal sinuses, or central nervous system.
Node. 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.
Distant metastasis. The “M” in the TNM system indicates whether the cancer has spread from the eyelid to other parts of the body.
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.
Histopathology and grading
Histology describes how closely the cancer cells resemble normal tissue under a microscope. A tumor's grade is described using the letter G and a number.
GX: The tumor grade cannot be identified.
G1: Describes cells that look more like normal tissue cells (well differentiated).
G2: Describes cells that look somewhat different from normal cells (moderately differentiated).
G3: Describes tumor cells that look very much unlike normal cells (poorly differentiated).
G4: The tumor cells barely resemble normal cells (undifferentiated).
Recurrent: Recurrent cancer is cancer that comes back after treatment.
Used with permission of the American Joint Committee on Cancer (AJCC), Chicago, Illinois. The original source for this material is the AJCC Cancer Staging Manual, Sixth Edition (2002) published by Springer-Verlag New York, www.springer-ny.com.
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.
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.
Doctors and scientists are always looking for better ways to treat patients with eyelid cancer. A clinical trial is a way to test a new treatment to prove that it is safe, effective, and possibly better than a standard treatment. Patients who participate in clinical trials are among the first to receive new treatments before they are widely available. However, there is no guarantee that the new treatment will be safe, effective, or better than a standard treatment.
Patients decide to participate in clinical trials for many reasons. For some patients, a clinical trial is the best treatment option available. Because standard treatments are not perfect, patients are often willing to face the added uncertainty of a clinical trial in the hope of a better result. Other patients volunteer for clinical trials because they know that finding new drugs and other therapies is the only way to make progress in treating eyelid cancer. Even if they do not benefit directly from the clinical trial, their participation may benefit future patients with eyelid cancer.
To join a clinical trial, patients must complete a learning process known as informed consent. During informed consent, the doctor should list all of the patient’s options, so the person understands how the new treatment differs from the standard treatment. The doctor must also list all of the risks of the new treatment, which may or may not be different from the risks of standard treatment. Finally, the doctor must explain what will be required of each patient in order to participate in the clinical trial, including the number of doctor visits, tests, and the schedule of treatment. Learn more about clinical trials, including patient safety, phases of a clinical trial, deciding to participate in a clinical trial, questions to ask the research team, and links to find cancer clinical trials.
Cancer and its treatment can cause a variety of side effects. However, doctors have made major strides in recent years in reducing pain, nausea and vomiting, and other physical side effects of cancer treatments. Many treatments used today are less intensive but as effective as treatments used in the past. Doctors also have many ways to provide relief to patients when such side effects do occur.
Fear of treatment side effects is common after a diagnosis of cancer, but it may be helpful to know that preventing and controlling side effects is a major focus of your health-care team. Before treatment begins, talk with your doctor about possible side effects of the specific treatments you will be receiving. The specific side effects that can occur depend on a variety of factors, including the type of cancer, its location, the individual treatment plan (including the length and dosage of treatment), and the person’s overall health.
Ask your doctor which side effects are most likely to happen (and which are not), when side effects are likely to occur, and how they will be addressed by the health-care team if they do happen. Also, be sure to communicate with the doctor about side effects you experience during and after treatment. For more information on the most common side effects of cancer and different treatments, along with ways to prevent or control them, visit Cancer.Net’s section on Managing Side Effects, based on ASCO’s curriculum.
In addition to physical side effects, there may be psychosocial (emotional and social) effects as well. Learn more about the importance of addressing these needs in Cancer.Net’s section on Caring for the Whole Patient.
For more information on late effects or long-term side effects, please read the After Treatment section or talk with your doctor.
After treatment for eyelid cancer ends, talk with your doctor about developing a follow-up care plan. This plan may include regular physical examinations and/or medical tests to monitor your recovery for the coming months and years. Most patients treated for eyelid cancer are successfully treated with a good cosmetic result.
Most people do not have any long-term effects because of the cancer. However, people treated for eyelid cancer need close observation by their ophthalmologist and oncologist to ensure that the tumor does not recur or spread to other organ systems. The doctor will make recommendations regarding the frequency of necessary follow-up examinations. In some circumstances, your doctor may also recommend routine blood and imaging testing to ensure that there is no recurrence or spread of the tumor.
Some side effects may occur months or years after treatment and therefore continued follow-up care by your doctor is essential.
Many patients with eyelid cancer require reconstructive surgery. Reconstructive surgery differs from cosmetic surgery, in that it is generally performed to improve function, but may also be done to approximate a normal appearance; cosmetic surgery is performed on normal structures for the purpose of appearance. A surgeon may use skin grafts in order to completely reconstruct the eyelid and give patients a normal appearance.
Research involving more advanced diagnostic procedures and treatment for eyelid cancer is ongoing. The following advancements may still be under investigation in clinical trials and may not be approved or available at this current time. Always discuss all diagnostic and treatment options with your doctor.
A number of clinical trials for eyelid cancer are currently underway. There have been significant advances in surgical procedures to look for spread of a tumor from the periocular area (the area around the eye) to regional lymph nodes. Sentinel lymph node biopsy is one such technique. You may want to ask your doctor whether such a procedure is available.
There have been numerous advances in the management of skin melanoma with a focus on vaccines that may be helpful in preventing future spread. Cancer vaccines are experimental treatments that stimulate a person’s own immune system to fight cancer. In addition, new therapeutic combinations of chemotherapy for those with advanced metastatic disease are also under investigation.
Regular communication with your doctor is important in making informed decisions about your health care. Consider asking the following questions of your doctor:
General questions:
What type of eyelid cancer has been diagnosed?
What stage is the cancer? What does this mean?
Can you explain my pathology report to me?
Do I need treatment right away?
What are my treatment options?
What clinical trials are open to me?
What treatment do you recommend? Why?
What is the goal of this treatment?
What are the possible side effects of this treatment, both in the short term and the long term?
How will this treatment affect my daily life? Will I be able to work, exercise, and perform my usual activities?
What support services are available to me? To my family?
For people who need surgery:
What type of surgery is recommended? Why?
What are the side effects of this surgery?
Will I need to stay in the hospital for this surgery? For how long?
Will my vision be affected? For how long?
Will I need reconstructive surgery?
For people who need radiation treatment:
What type of radiation therapy is recommended?
What does the preparation for this treatment involve?
What is the likelihood of my eye being damaged?
What other short-term and long-term side effects can I expect from this treatment?
What can be done to relieve side effects?
For people who need an eye removed:
How do I adjust to having one eye?
How long will it take me to recover physically?
How soon can I get a prosthesis (artificial eye)?
When do I get a permanent prosthesis?
How do I care for my prosthesis?
After treatment:
What are the chances that the cancer will return?
What follow-up tests do I need, and how often do I need them?
Printer-Friendly
E-mail this page