What you need to know about Eyelid Cancers

The eyelids are specialized parts of the face that work to protect the eye.  They are composed of very thin skin and muscle, sebaceous glands, sweat glands, and apocrine glands.  An eyelid cancer can arise from any of these tissues, but most commonly cancers in the lid come from the skin.  Basal cell carcinoma (BCC) is the most common type of cancer, followed by squamous cell carcinoma (SCC), and the more rare malignant melanoma. Sebaceous cell carcinoma arises from the sebaceous glands.

Basal cell carcinoma (BCC) accounts for approximately 80% of all nonmelanoma skin cancers and squamous cell carcinoma (SCC) accounts for almost 20%. The tumors most often appear in individuals aged 40-60 years with fair skin and sunlight exposure. These tend to be slow growing forms of skin cancer and rarely spreads to other areas of the body, but if left untreated, can disfigure, ulcerate and invade the orbit and eye.

BCC and SCC eyelid cancers often appear as painless elevations or nodules, sometimes with a pearly appearance, and/or loss or distortion of the eyelashes.  There may be ulceration of the involved area, with bleeding, crusting, redness and/or distortion of the normal skin appearance.  Squamous cell carcinoma is frequently preceded by the presence of actinic keratosis (AK). These precancerous lesions appear as scaly plaques or papules, often with an erythematous base. Both BCC and SCC tend to occur most often on the lower eyelids.

Melanoma is a malignancy of pigment-producing cells (melanocytes). While melanoma accounts for roughly 4% of all skin cancers, it is responsible for more than 74% of skin cancer deaths. Treatment of melanoma in its early stages provides the best opportunity for cure.

Sebaceous cell carcinoma makes up 0.8% of all eyelid tumors, with a mortality rate is 22%.  Sebaceous cell carcinomas are typically found in women, more often in the seventh decade of life, and they usually are on the upper eyelid margin. The clinical appearance of sebaceous gland carcinoma is highly variable. They more often occur on the upper eyelid and have a yellowish appearance.

Any lesion on an eyelid that is suspicious for a cancer requires a biopsy to confirm the diagnosis. Early detection following by treatment to remove the cancer completely is critical to prevent undesirable growth.

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