Eyelid Tumours
The most common malignant lesion of the eyelids and surrounding area is a Basal Cell Carcinoma (BCC), also known as a Rodent Ulcer. In the UK this condition will affect approximately 300 in every 100,000 people. The incidence is higher in hotter climates such as Australia where figures rise to about 850 in every 100,000 of the population. 90% of all basal cell carcinomas occur on the face, with 10% affecting the eye region, most commonly the lower eyelids.
Basal cell carcinomas can present in a variety of ways but most often there is either a firm lump (nodular BCC) or an area of skin that intermittently bleeds and never completely heals up (ulcerative BCC). Growth tends to be slow over many months or years, and often people are not especially concerned about the lesion for some time. Unlike benign lesions a malignant lesion will tend to be more destructive of nearby structures eg loss of eyelashes from a BCC on the eyelid margin, and if neglected can cause significant irreversible damage to delicate structures around the eye. BCC's are unusual malignant tumours in that even if left to grow quite large they do not spread (metastasize) to other parts of the body.
Nodular BCC right lower lid
Nodular BCC inner corner left eye
Management
There are many ways to treat a BCC eg topical creams, radiotherapy, cryotherapy but surgical removal is the best option in the vast majority of cases. Oculoplastic surgeons are trained to advise on the management of these lesions and tailor the treatment depending on many factors including the size and location of the tumour. Occasionally higher risk lesions are removed using a specialised Mohs Micrographic Surgery technique which involves the abnormal tissue being fully examined to ensure complete removal before the defect is repaired, usually later on the same day. The removal of larger lesions may require the use of reconstructive techniques that can involve skin and muscle flaps or skin grafts.
Ulcerated BCC left lower lid
Same patient 2 weeks after removal and repair with cartilage-like graft from upper lid and skin flap from side of the nose
Defect following surgical removal of BCC from inner corner of right eye
One week following defect repair with skin flap from forehead
Extensive defect following excision of large BCC using Mohs micrographic surgery
Six months following defect repair using a combination of skin flaps
Shallow defect in left lower lid following excision of BCC
Two weeks following repair using a tissue cartilage-like graft from the upper lid and a skin advancement flap
Large defect right upper cheek following excision of BCC
Photograph immediately after defect repaired with a full thickness skin graft taken from in front of right ear (the graft becomes much less obvious after a few months)
Photograph of skin graft donor site at the end of the procedure
Other rarer and often more serious malignant tumours around the eyes include Squamous Cell Carcinoma, Sebaceous Cell Carcinoma and Malignant Melanoma. These conditions are managed by a multi-disciplinary team approach which in addition to the oculoplastic surgeon may include specialist dermatologists, radiologists, oncologists and histopathologists.
Rapidly growing squamous cell carcinoma
Aggressive sebaceous gland carcinoma arising from under left upper lid