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Eyelid Tumours

Essentials

  • The eyelids and the skin around the eyes are more exposed to sunlight than the rest of the body. Constant UV radiation increases the risk of tumours in the facial area.
  • GPs should recognize basal cell carcinoma of the eyelids and refer patients sufficiently early to treatment by an ophthalmologist.

Benign eyelid tumours

  • Most eyelid tumours are benign.
  • Classification
    • Pigmented tumours, such as seborrhoeic keratosis, freckles and warts
    • Nonpigmented tumours, such as papilloma, Moll (ciliary) gland cysts, milia and xanthelasma
    • Vascular tumours, such as haemangiomas and flame naevi
      • More common in children

Premalignant and borderline tumours

  • The most common tumour of this group is actinic keratosis.
  • Other tumours in the group include Bowen's disease and lentigo maligna, for example.

Malignant eyelid tumours

  • Basal cell carcinoma is the most common (90% of malignant eyelid tumours; see below).
  • Other
    • Squamous cell carcinoma
    • Melanoma
    • Kaposi's sarcoma (note the possibility in patients with AIDS, in particular)
  • If a malignancy is suspected, the differential diagnosis will often be made by an ophthalmologist or a dermatologist.

Symptoms and findings

  • A lump that is visible to the naked eye or palpable
  • A raised or scar-like lesion or distorted eyelid margin (may cause a foreign body sensation)
  • Abnormal scaling, colour or vasculature of the eyelid skin
  • Loss of eyelashes
  • Bleeding skin lesion
  • Chronic ulcer in the eye area

Workup

  • Eyelid photography (for referral and follow-up)
  • Measurement of the size of the lesion
  • Palpation of the lymph nodes in the neck area and face
  • Biopsy, as necessary (to be taken from the eye area by an ophthalmologist or a dermatologist)

Differential diagnosis

Treatment

  • Benign eyelid tumours should be treated if they cause functional impairment.
  • Malignant tumours are often treated surgically. In addition, cryotherapy, pharmacotherapy or radiotherapy can be used, as necessary.

Basal cell carcinoma of the eyelid

  • Often situated at the eyelid margin. May sometimes grow rapidly.
  • There is often a crater-like depression in the centre.
  • Risk factors: UV radiation from the sun, previous lesions or scars in the eyelid area, immunosuppression
  • Does not metastasize. The tumour is classified as malignant because of its rapid growth and tendency to infiltrate deeper tissues if left untreated.

Symptoms and findings

  • Often nodular
  • Typical features
    • Sharply defined
    • Crater-like lesion in the centre
    • Skin-coloured
    • Overlying telangiectasia
  • May be asymptomatic.

Workup

  • Biomicroscopy performed by an ophthalmologist
  • Biopsy, as necessary
  • Histological sample taken in association with excision

Treatment

  • Surgical excision is the primary treatment.
  • Photodynamic therapy and topical treatment with imiquimod cream can also be considered.

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