What is eyelid cancer?
Eyelid cancer is a general term used for a cancer that occurs on or in the eyelid. Cancer starts when cells change and start to grow uncontrollably, forming a tumour. A tumour can either be benign or malignant. A benign tumour is not considered to be cancerous although it can grow, it will generally not spread to other parts of the body. However, a malignant tumour can grow and spread to other parts of the body.
Most eyelid cancers are similar to skin cancers in other sun exposed areas . Around 5% to 10% of all skin cancers occur in the eyelid. Skin cancers most commonly occur on the lower eyelid, but they can also start on the upper eyelid, eyebrow or the corners of the eye.
Most eyelid cancers – around 9 out of 10 – are basal cell carcinomas. Although malignant, these usually have a favourable course in comparison to the other cancer types, if caught early, and most commonly affect people with fair skin. Other rarer types include sebaceous cell carcinoma, squamous cell carcinoma and melanoma, which can become troublesome if they spread to contiguous anatomic structures (e.g., the eyeball) and/or life-threatening if they spread to other parts of the body.
What causes eyelid cancer?
The most important cause of eyelid cancer is exposure to ultraviolet (UV) radiation from the sun or other sources such as tanning beds. This can cause damage to the DNA of skin cells, which can trigger a cell to start to grow out of control, forming a tumour. Because the eyelid has the thinnest skin on a person’s body, it is very sensitive to this type of damage.
People living in places with year-round bright sunlight and those who spend a lot of time outdoors or on tanning beds are at an increased risk of developing eyelid cancer. People with fair or pale skin have a higher chance of developing the disease compared to those with darker skin tones.
What are the most common types of eyelid cancer?
An eyelid tumour can begin in different types of cells that make up the tissues of the eyelid. These include: the skin, conjunctiva, and the glands that secrete oil and sweat.
The five main types of eyelid cancer are:
- Basal cell carcinoma is by far the most common type of eyelid cancer. These tumours arise from basal cells, which are round cells found in the deepest part of the outer layer of skin (the epidermis). They are often related to sun exposure, usually appearing in the lower lid and most commonly affecting people with fair skin. Some people with basal cell carcinoma will notice a pearly lump slowly forming on their eyelid. Basal cell carcinomas are usually slow growing and it is very unlikely for these tumours to spread to other parts of the body. Basal cell carcinoma is almost always curable, especially if found and treated early. However, if left untreated, it can continue to grow and cause damage to surrounding and distant tissues.
- Sebaceous cell carcinoma is the second most common eyelid cancer. It starts in the sebaceous glands, which produce natural skin oils. People may notice a firm, painless lump or thickening of the skin on their eyelid (commonly the upper eyelid). Sebaceous carcinoma can grow quickly and can sometimes spread to other parts of the body.
- Squamous cell carcinoma starts in squamous cells, which are just above the basal cells and from the rest of the The squamous cells are continuously shed from the surface of the skin and replaced. These tumours are usually associated with sun exposure. Some people may notice a whitish thickening or ulceration of the eyelid skin. Squamous cell carcinomas can be aggressive and can spread to other parts of the body, but this is rare.
- Melanoma starts in cells in the skin called melanocytes found in the deepest layer of the epidermis. These cells produce a pigment called melanin that gives the skin its natural colour and helps protect the body from the ultraviolet light from the sun. Melanoma can sometimes develop from a ‘mole’ (also called naevus) that a person already has on their eyelid, but it can also develop where there is no existing mole. This type of tumour is less common than other types of eyelid cancer – but it’s more dangerous as it is much more likely to grow and spread to other parts of the body.
- Merkel cell carcinoma is a very rare eyelid tumour, which typically occurs in elderly patients in UV-exposed skin. It may be very aggressive and often spreads to other parts of the body. Merkel cell polyomavirus has been detected in about 80% Merkel cell carcinomas tested. This tumour has characteristic microscopic changes, and must always be considered in the differential diagnosis of eyelid cancers.
What causes eyelid cancer?
The most important cause of eyelid cancer is exposure to ultraviolet (UV) radiation from the sun or other sources such as tanning beds. This can cause damage to the DNA of skin cells, which can trigger a cell to start to grow out of control, forming a tumour.
People living in places with year-round bright sunlight and those who spend a lot of time outdoors or on tanning beds are at an increased risk of developing eyelid cancer. People with fair skin have a higher chance of developing the disease compared to those with darker skin tones.
Some of the main risk factors that can influence a person’s chances of developing eyelid cancer include:
- UV radiation – most eyelid cancers are caused by exposure to ultraviolet (UV) radiation from the sun or sunbeds. This could be long-term exposure or shorter periods of intense exposure and burning.
- Fair skin – people with lighter coloured skin that has a tendency to burn rather than tan have an increased risk of developing eyelid cancer. This is because their skin contains less of the protective pigment called melanin, produced by melanocytes, which are found in the deepest layer of the epidermis. But people with darker coloured skin can also develop the disease.
- Age – the risk of eyelid cancer increases with age, but younger people can also develop the disease. For example, most basal and squamous cell cancers more commonly occur in people older than 50 years of age.
- History of sunburn – skin that has been affected by sunburn from exposure to UV radiation has an increased risk of eyelid cancer.
- Previous skin cancers – people who have already had skin cancer are at greater risk of getting it again compared to those who have not. This is most likely because of their history of sun exposure.
- Other skin conditions – people with certain rare genetic conditions may have an increased risk of developing eyelid cancers. These include Gorlin-Goltz syndrome, Muir Torre Syndrome and xeroderma
- Weakened immune system – people with weakened immune systems or who use certain medications are at higher risk of developing eyelid cancer.
What are the signs and symptoms of eyelid cancer?
People may experience a range of symptoms or signs of eyelid cancer. The main warning signs are changes to the skin in the upper or lower eyelid, but these tumours can look very different and the symptoms can vary from person to person.
To spot eyelid cancer early, it’s important to know how your skin normally looks and notice any changes that occur. Look out for sores or areas of eyelid skin that doesn’t heal, looks unusual – or hurts, itches, bleeds, crusts or scabs.
Common symptoms of eyelid cancer include:
- A sore that doesn’t heal – this may vary in colour and may feel sore
- Swelling or thickening of the eyelid
- Chronic infection of the eyelid
- A change in the appearance of the eyelid skin – such as red patches that may be itchy
- A lump on the eyelid – this might be small, slow growing, shiny and pink or red
- Broken skin on the eyelid that doesn’t heal (ulceration)
- Loss of eyelashes
But sometimes people with eyelid cancer do not have any of these symptoms – or they may be due to another condition that is unrelated to cancer. If you have any of these symptoms – or any other changes to your eyes or eyelids – it’s important to get examined by your GP or eye care professional.
How is eyelid cancer diagnosed?
Doctors use many different types of tests used to diagnose eyelid cancer. They may also carry out tests to find out whether the disease has spread to other parts of the body – or to find out which treatments could be most effective.
In addition to a physical examination, the following tests may be used to diagnose eyelid cancer – but not all these tests will be used for every patient.
- Biopsy – this surgical procedure involves removing a tiny sample of the suspicious tissue (or sometimes the entire tumour: an excisional biopsy), under a local anaesthetic, which is applied to numb the affected area. The sample is then sent to the laboratory for examination under a microscope by a histopathologist (who study organs, tissues, cells and genetics to help provide a diagnosis). to look for the presence of cancer cells. A biopsy is the only test that can make a definite diagnosis of cancer. If the tumour is found to be cancerous and the surgeon has removed the whole tumour and a suitable margin of surrounding tissue, there may be no need for any further treatment. As some skin cancers are malignant, there is a risk that the disease may have spread beyond the eyelid to other parts of the body. In these cases, the doctor may recommend other diagnostic tests. These include imaging scans that can help doctors to see where the cancer is in the body and measure the tumour size, or a sentinel node biopsy – which is a surgical procedure that is used to determine if the cancer has spread to the lymphatic system.
- Computed tomography (CT or CAT) scan – this a test that uses x-rays and a computer to generate detailed images of the inside of the body. It works by taking pictures from different angles, which the computer then builds into a three-dimensional (3D) image that shows any abnormalities or tumours.
- Magnetic resonance imaging (MRI) – MRI is a type of scan that uses magnetism and radio waves to take pictures inside the body. An MRI scan can be used to look at most areas of the body and show up soft tissues very clearly.
- Positron emission tomography (PET) scan – a PET scan uses a mild radioactive sugar substance (called a tracer) that is injected into the patient’s body. This is taken up by cells that are more active than others, such as cancer cells. A scanner detects this substance to create images of the inside of the body.
- Ultrasound – this is a type of scan that uses high frequency sound waves to create a picture of a part of the inside of the body. The ultrasound scanner has a probe that gives off sound waves that bounce off the organs inside the body, which are then picked up by the probe. The probe is linked to a computer that turns the sound waves into a picture on the screen.
- Sentinel node biopsy – this is a test to find the first lymph nodes or nodes that a cancer may have spread to. It is a surgical procedure that involves injecting a dye into the area around the site of the cancer, which will gradually drain into the nearby sentinel nodes. The surgeon can see the dye, which will help them to remove the nodes and send them to the laboratory for examination under a microscope to see if they contain cancer cells.
How is eyelid cancer treated?
The sooner that eyelid cancer is diagnosed, the easier it is to treat successfully (i.e., to cure it). The treatment will depend on the type of cancer, how far it has grown or spread, how big it is, and the person’s overall health. Most people with eyelid cancer will only need surgery. But if their cancer is more advanced and has spread to other parts of the body, the treatment options include surgery, radiotherapy, chemotherapy, immunotherapy and targeted drugs.
Some of the most common treatment options for eyelid cancer are:
Surgery - The main treatment for most eyelid cancer is surgery to remove the tumour and a small margin of the healthy surrounding tissue. This treatment will often be followed by reconstructive surgery to repair the damaged area and improve eye function.
Lymph node dissection - A person might also have surgery to remove the lymph nodes in the area if tests show the disease has spread there.
Radiotherapy - uses high-energy radiation to destroy cancer cells. It might be used to treat cancer that is difficult to treat with surgery. The most common type of radiotherapy is external-beam radiation therapy, which directs beams at the tumour from a machine outside the body.
Topical chemotherapy - involves using drugs to destroy cancer cells. Eyelid cancers may be treated with a chemotherapy cream (topical treatment) that is applied directly to the affected area.
Targeted drugs and immunotherapy - Targeted drugs work by targeting specific biomarkers in cancer cells that help them to grow and survive. Drugs called immunotherapies that aim to help the body’s immune system to recognise and attack cancer cells.
Cryotherapy – this treatment uses extreme cold to kill cancer cells. It is also called cryosurgery or cryoablation. During cryotherapy treatment, the doctor will use liquid nitrogen to freeze the tumour.
Eye removal – although it is rare, for some aggressive types of eyelid cancer, it is necessary to remove a person’s whole eye to stop their disease from spreading to other parts of the body. Due to the sight loss caused by the removal of an eye, a person may experience trouble with their depth perception (3D vision) and field of vision, and may therefore need additional support to help them to adjust to this change.
What research is underway into eyelid cancer?
Currently, the main treatment for aggressive eyelid cancers is surgery – but this can seriously change a person’s appearance or even leave them blind on the affected side. Researchers are aiming to understand why some tumours behave so aggressively, which could pave the way to new treatments that can stop a cancer from spreading without the need for such drastic surgery.
John Bladen at Barts and The London School of Medicine and Dentistry is developing intricate 3D models using cells taken from eyelid cancers to investigate the molecular mechanisms behind the aggressive behaviours that enable tumour spread. He is aiming to improve our understanding of the growth and development of eyelid cancers with a view to identifying less invasive, kinder treatments in the future.
Think you have Eyelid Cancer? Here's what to do.
The best way to reduce the risk of eyelid cancer is to take steps to protect this area of the body from exposure to damaging UV radiation – such as by wearing a wide-brimmed hat and UV-blocking sunglasses on sunny days and the daily use of an SPF 30+ sunscreen or moisturiser. Other measures include avoiding the use of sunbeds and preventing sunburn, especially in children.
To spot eyelid cancers early, it’s important to know how the skin around your eyes looks normally so you can notice any changes more easily. Visit your GP for an examination, early, if you are concerned about any symptoms that you may have.
Last updated December 2022
Approved by Sarah Coupland, University of Liverpool