Traditionally the best treatment for eyelid tumours is to remove the abnormal tissue surgically and repair the defect, often with a local skin flap or occasionally using a skin graft from another site eg: taken from behind the ear.

Over the last few years new topical treatments have become available and are used extensively by dermatologists for some superficial skin cancers. Some of these agents are now being tried for certain lesions around the eyes, where the skin is thinner and more delicate.

In the October 2012 issue of Eurotimes, Robert Kersten MD, from the University of California, shares his experience of using the topical immune sensitizer imiquimod. This agent was first approved, by the relevant authorities in the USA, for use with superficial skin tumours in 2004. It is applied as a cream and works by boosting the patient’s immune system to destroy the abnormal skin tumour cells. To try and limit side effects such as burning, itching, crusting and ulceration it generally needs to be applied 5 days a week when used around the eyes (ie not used at the weekend). Small series case reports suggest that ocular side effects are fairly common but relatively mild eg: 15 patients developed conjunctivitis, but no permanent problems, in one 47 patient study.

Treating eyelid tumours can be challenging. The primary aims are almost always to completely clear the abnormal tumour cells, preserve structure and function of important tissues and have the best possible aesthetic result. The use of new topical agents, such as imiquimod, is an exciting additional option which can be recommended under certain circumstances, especially when it is desirable to avoid surgery. Patients with benign and cancerous lesions around the eyes require an expert assessment for accurate diagnosis and advice regarding all the possible treatments available. This allows an individualised tailored management plan to achieve the best possible outcome for any given situation.