Skin cancer is a common malignancy, particularly in sunny climates such as Florida. Eyelid skin cancers are most prevalent on the lower eyelid. They typically appear as painless elevations or nodules along the eyelid margin. The eyelashes may be distorted or missing. Ulcerations, bleeding or crusting may be present. Basal cell carcinomas and squamous cell carcinomas are most common. After the skin cancer is removed, the defect is reconstructed. The goals of treatment are complete tumor excision, and functional, aesthetically pleasing reconstruction.
The majority of eyelid growths – old and new – are benign. However, skin cancers can occur on the eyelid – in the lash line or in the skin.
If an eyelid growth has associated redness, recurrent crusting, ulceration, bleeding, loss of eyelashes or irregular borders, skin cancer is suspected and must be ruled out.
Basal Cell Carcinoma
Basal cell carcinoma is the most common skin cancer found on the eyelids. It accounts for 90-95% of eyelid malignancies. They most commonly occur on the lower eyelid but can be found in the inner eyelid near the nose, the upper lid or outer eyelid.
Who Is At Risk To Develop Basal Cell Carcinoma?
People of older age, with fair skin, blue eyes, red or blond hair with Scottish, English, Irish or Scandinavian ancestry are most at risk to develop a basal cell carcinoma of the eyelid. Significant sun exposure and sunburns in the first 20 years of life, cigarette smoking, and a prior history of basal cell carcinoma also increase your risk.
While basal cell carcinomas come in several different forms, nodular basal cell carcinoma is the most common clinical lesion. The growths are described as a firm, raised, pearly nodule with central ulceration and associated increased vascularity (telangiectasia).
How Do You Diagnose A Basal Cell Carcinoma?
A biopsy is performed in the office and the specimen sent for pathology review. Prior to biopsy, the lesion is photographed as the biopsy site can at times heal well enough that the original area is difficult to identify once it has healed.
How Do You Treat Eyelid Basal Cell Carcinomas?
An eyelid basal cell carcinoma needs complete tumor excision, with pathologic proof of clear margins, and careful reconstruction. I prefer to utilize a team approach and schedule my patients with a Mohs dermatologist to excise cancer in their office under local anesthesia. Utilizing a Mohs micrographic technique, complete tumor removal is possible while creating a small tissue defect.
The physician numbs the skin, removes any suspicious tissue along with some normal tissue and examines the specimen under the microscope. If any tumor remains, they carefully excise more tissue in a very conservative manner, process the specimen and review the tissue under the microscope. The process is repeated until the entire cancer has been removed. The patient is then patched and is driven to the surgery center where I repair the defect under sedation. As an oculoplastic specialist, I have the training and experience to meticulously reconstruct the defect. The goal is to preserve proper lid position which will then protect the eyeball and the vision.
Squamous Cell Carcinoma
Squamous cell carcinomas are much less common on the eyelid compared to basal cell carcinoma, but they are much more aggressive. They can appear as a new lesion or progress to cancer from an area of sun damage. Squamous cell carcinomas can have a varied appearance but in general are persistent, scaly/crusty, thick growths that occasionally bleed. Management is similar to basal cell carcinomas and involves Mohs micrographic surgery followed by reconstruction.
If neglected, these tumors can be lethal. Squamous cell carcinoma can spread along nerves, extend out directly or travel through the blood or lymphatic systems.
Suspicious eyelid lesions need thorough evaluation and biopsy to obtain a definitive diagnosis and treatment plan.