Eyelid cancer

What is eyelid cancer?

Eyelid cancer is a term used for 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 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 skin cancers. As the skin in this area is very thin, it is easily damaged by sun exposure – and so it is a common place for these tumours to develop. Skin cancers most commonly occur on the lower eyelid, but they can also start on the upper eyelid, eyebrow or in the corners of the eye.

Most eyelid cancers – around 9 out of 10 – are basal cell carcinomas. These are usually benign and most commonly affect people with fair or pale skin. Other rarer types include sebaceous cell carcinoma, squamous cell carcinoma, and melanoma – which can become 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 signs and symptoms of eyelid cancer?

People may experience a range of symptoms or signs of eyelid cancer which can include:

  • Swelling or thickening of the eyelid skin

  • Chronic infection of the eyelid

  • A change in the appearance of the eyelid skin

  • A spreading, coloured growth on the eyelid that can be red, brown or black

  • 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 an eye care professional.

How is eyelid cancer diagnosed?

An ophthalmologist (hospital eye doctor) will carefully examine any abnormality of the eyelid. To confirm a cancer diagnosis, they will need to perform a surgical biopsy that involves removing a tiny sample, or sometimes the whole tumour. They will then send this to the laboratory for microscopic evaluation for the presence of cancer cells.

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, or a sentinel node biopsy – which is a surgical procedure that is used to determine if the cancer has spread to the lymphatic system.

How is eyelid cancer treated?

The sooner an eyelid cancer is diagnosed, the easier it is to treat successfully. The main treatment for most eyelid cancers is surgery to remove the tumour and a small margin of the healthy surrounding tissue. This will often be followed by reconstructive surgery to repair the damaged area and improve eye function.

Other potential treatments include radiotherapy, topical chemotherapy drugs (usually eye drops or creams) applied to the affected area, or cryotherapy – the use of liquid nitrogen to freeze the tumour.

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 and may need additional support to help them to adjust to this change.

If a person’s eyelid cancer is more advanced and has spread to other parts of their body, the treatment options include surgery, radiotherapy, chemotherapy, immunotherapy (which aims to boost the body’s own immune system to fight their cancer) and targeted drugs.

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.

What can I 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 if you are concerned about any symptoms that you may have.

Last updated July 2019
Approved by Mr John Bladen, Moorfields Eye Hospital

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