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)
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 (pictures F1F3). 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.
References
Shi Y, Jia R, Fan X. Ocular basal cell carcinoma: a brief literature review of clinical diagnosis and treatment. Onco Targets Ther 2017;(10):2483-2489. [PubMed]
Yin VT, Merritt HA, Sniegowski M, et al. Eyelid and ocular surface carcinoma: diagnosis and management. Clin Dermatol 2015;33(2):159-69. [PubMed]