Cancers of the eyelid

The term cancer implies uncontrolled unregulated growth. Like elsewhere in the body, small clusters of cells within the eyelid can start to grow and proliferate uncontrollably leading to a malignant tumour. Eyelid cancer work forms a significant proportion of work for most oculoplastic surgeons. The management of most eyelid cancers involves surgery to remove the cancer followed by reconstruction of the region to give as good a functional and cosmetic result as possible for the patient.

Basal Cell Carcinoma

Basal cell carcinoma (rodent ulcer) is the commonest cancer of the eyelid. The classic presentation of a BCC is a hard nodule with a pearly edge, often with dilated blood vessels on its surface (telangiectasia) and central ulcer formation as the BCC enlarges.

  • Neglected basal cell carcinoma
  • Typical BCC: Note the central ulcer and the loss of eyelashes

Eyelid BCCs arise from within the superficial layers of skin, most commonly involving the lower eyelid. The risk of BCC development in any particular person is related in part to the fairness of that person’s skin and the amount of sun exposure that person receives. Although it does not spread to distant sites (metastasis), it can continue to enlarge and invade surrounding structures. On the whole, surgery for larger tumours is likely to be more extensive.

Although the best chance of cure of eyelid cancers is via complete surgical removal; some patients with BCC may be treated with other methods e.g. radiotherapy, cryotherapy, topical chemotherapy, immunotherapy.

Less commonly, other types of cancers may develop around the eye e.g. malignant melanoma, squamous cell carcinoma, sebaceous gland carcinoma. They are by far much less common than BCCs, but their management on the whole requires more radical treatment than BCCs, at times involving joint care with other types of doctors e.g. oncologists, maxillofacial surgeons, general plastic surgeons, due to their ability to spread to distant sites.

BCCs differ from most cancers in that they rarely spread to distant sites.

All skin cancers around the eyelids are designated as high risk skin cancers by the British Association of Dermatologists and as such should be treated seriously.

Eyelid Cancer Surgery Gallery

Click images to start gallery
(Warning: some of the pictures are quite graphic and may cause distress)

BCC Rodent Ulcer
Lower lid BCC: Note the loss of eyelashes and central ulcer
Morpheaform infiltrative BCC
Morpheaform infiltrative BCC: This type of BCC is more dangerous in that it is almost invisble. Note the characteristic eyelash loss
Following removal of the lesion. A large full thickness defect results
Oculoplastic surgeons are trained to reconstruct these eyelid defects. This was 3 weeks following complex reconstruction
4 months following reconstruction surgery. The eyelashes never grow back but the patient was clear of the cancer
Nodular BCC
Nodular BCC: This BCC was allowed to grow for 3 years before the patient decided to seek treatment
Oculoplastic surgeons remove not only what tumour is apparent to the eye but also a rim of normal looking tissue around the tumour.
A large skin defect results. This defect was reconstructed using a sliding cheek flap (Mustarde flap)
1 week following reconstruction with a sliding cheek flap. Note the swelling
4 months following reconstruction. Note the swelling has resolved
Basal cell carcinoma (BCC): Note the central ulcer, hence their common name - rodent ulcer
3 days following removal of the tumour. Here some skin from the temple was rotated inwards (Rhomboid flap)
4 weeks following surgery. The patient was advised to massage the reconstructed area to blend away the scars.
Morpheaform Basal cell carcinoma  BCC
Morpheaform BCC: These are quite dangerous as they are almost invisible.
Immediately following Mohs Surgery. A large defect results
1 week following reconstructional oculoplastic surgery which consisted of multiple flaps. Note the residual swelling
4 months following reconstructional surgery. The eyelid swelling has resolved and the flaps have almost disappeared. The eyelashes never grow back.
4 months following reconstruction surgery
Mixed infiltrative nodular BCC
Very poorly defined mixed infiltrative nodular BCC. These lesions are particularly dangerous with a propensity to invade into the eye socket
Following Mohs Micrographic Surgery. A much larger defect than expected is visible.
1 week following oculoplastic surgical reconstruction using a flap of skin mobilised from the central forehead (glabellar flap)
1 week following reconstruction.
4 months following reconstruction. Note the scars have almost disappeared.