Eyelid cancer

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, which can grow and spread to other parts of the body - this is sometimes described as a malignant tumour.

Most eyelid cancers are similar to skin cancers in other sun-exposed areas. 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.

It's also possible to have a benign tumour on your eyelid. A benign tumour is not considered to be cancerous. It can grow, but will generally not spread to other parts of the body.

What are the different types of eyelid cancer?

The difference between the types of eyelid cancer comes from the fact that they begin in different types of cells. Carcinomas usually come from cells in your epidermis (the outer layer of skin) and melanoma comes from melanocytes, the cells produce melanin (the pigment that gives skin its colour).

The five main types of eyelid cancer are basal cell carcinoma, sebaceous cell carcinoma, squamous cell carcinoma, Merkel cell carcinoma, and melanoma.

Basal cell carcinoma

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), and they are often related to sun exposure.

These tumours usually appear in the lower lid and most commonly affect 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 rare 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

Sebaceous cell carcinoma is the second most common eyelid cancer. It starts in the sebaceous glands, which produce natural skin oils, and 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

Squamous cell carcinoma starts in squamous cells, which are the cells of the skin's surface, just above the basal cells. These tumours are usually associated with sun exposure, and can appear as 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

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 that you already have on your eyelid, but it can also develop where there is no existing mole. 

This type of tumour can be dangerous as compared to other eyelid cancers, it is much more likely to grow and spread to other parts of the body.

Merkel cell carcinoma

Merkel cell carcinoma starts in the Merkel cells, which are involved in sensing touch, and is a very rare eyelid tumour, which typically occurs in elderly people with UV-exposed skin. It can 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.

Because the eyelid has the thinnest skin on your body, it is very sensitive to this type of damage.  

The main risk factors that can increase your chances of developing eyelid cancer are:

• Sunlight - people living in places with year-round bright sunlight and those who spend a lot of time outdoors are at an increased risk of developing eyelid cancer.
• Tanning beds – like sunlight, sunbeds or tanning booths expose you to ultraviolet (UV) radiation, so people who use sunbeds a lot are at higher risk of eyelid cancer.
• Fair or pale skin – people with lighter-coloured skin have higher risk of eyelid cancer than people with darker skin, and especially if your skin has a tendency to burn rather than tan.
• Age – the risk of eyelid cancer increases with age.
• History of sunburn – skin 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.
• Other skin conditions – rare genetic conditions like Gorlin-Goltz syndrome, Muir Torre Syndrome, and xeroderma may increase the risk.
• Weakened immune system – individuals with weakened immune systems or who use immune-suppressing medications are at higher risk.

What are the signs and symptoms of eyelid cancer?

Eyelid cancer can cause several different signs and symptoms. 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.

Common symptoms of eyelid cancer include:

• A sore that doesn’t heal, which may vary in colour and 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, which might be small, slow-growing, shiny, and pink or red
• Broken skin on the eyelid that doesn’t heal (ulceration)
• Loss of eyelashes

You can have eyelid cancer without having these symptoms, and these symptoms can be caused by other conditions that are not cancer. It’s important to get examined by your GP or eye care professional if you have any of these symptoms or any other changes to your eyes or eyelids.

Is eyelid cancer serious?

Most eyelid cancers – around 9 in 10 – are basal cell carcinomas, which are almost always curable if caught early, and don't tend to spread to other areas. Other types of eyelid cancer are rarer but can be life-threatening if they spread to other parts of the body.

Surgery for aggressive eyelid cancers can seriously change a person’s appearance or even leave them blind on the affected side.

How is eyelid cancer diagnosed?

Doctors use many different types of tests 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 determine which treatments could be most effective.

The following tests may be used to diagnose eyelid cancer:

• Biopsy – removing a tiny sample of the suspicious tissue, or sometimes the entire tumour, under a local anaesthetic. A biopsy is the only test that can make a definite diagnosis of cancer.
• Computed tomography (CT or CAT) scan – using X-rays and a computer to generate detailed images of the inside of the body.
• Magnetic resonance imaging (MRI) – taking pictures of inside the body (particularly soft tissue) using magnetism and radio waves.
• Positron emission tomography (PET) scan – using a mild radioactive sugar substance (tracer) that is injected into the body. A scanner detects this substance to create images of the inside of the body.
• Ultrasound – using high-frequency sound waves to create a picture 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 – a surgical procedure that involves injecting a dye into the area around the site of the cancer to find the first lymph nodes that a cancer may have spread to.

What are the treatments for eyelid cancer?

Most people with eyelid cancer will only need surgery. But if the cancer has spread to other areas, treatment options include surgery, radiotherapy, chemotherapy, immunotherapy and targeted drugs. Treatment will depend on the type of cancer, how far it has spread, how big it is, and the person’s health.

The sooner eyelid cancer is diagnosed, the easier it is to treat successfully. 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.

Common treatment options for eyelid cancer include:

• Surgery – to remove the tumour and a small margin of the healthy surrounding tissue.
• Lymph node dissection – removing the lymph nodes in the area if tests show the disease has spread there.
• Radiotherapy – uses high-energy radiation to destroy cancer cells.
• Topical chemotherapy – involves using chemotherapy cream applied directly to the affected area.
• Targeted drugs and immunotherapy – targeted drugs attack specific biomarkers in cancer cells; immunotherapies help the body’s immune system to recognise and attack cancer cells.
• Cryotherapy – uses extreme cold to kill cancer cells.
• Eye removal – in rare cases, the whole eye is removed to prevent the disease from spreading to other parts of the body.

What can help eyelid cancer?

To spot eyelid cancers early, it’s important to know how the skin around your eyes looks normally so you can notice any changes, and visit your GP if you are concerned. The best way to reduce the risk of eyelid cancer is to protect yourself from damaging UV radiation.

This includes wearing a wide-brimmed hat and UV-blocking sunglasses on sunny days, and using an SPF 30+ sunscreen every day, including on your eyelids. Avoiding the use of sunbeds and preventing sunburn, especially in children, are also important measures.

What research is there into eyelid cancer?

We're funding researchers who are aiming to understand why some eyelid tumours behave so aggressively. This could pave the way to new treatments that can stop a cancer from spreading without the need for drastic surgery that can even involve removing the eyeball.

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 aims to improve our understanding of the growth and development of eyelid cancers with a view to identifying less invasive, kinder treatments in the future.