Skin Cancer of the Eyelid
As our knowledge of the preventability of skin cancer increases, so too should the measures that we take to reduce our own risk. The importance of SPF and protecting the skin from sun exposure is routinely preached and practiced by most individuals. But is sunscreen itself enough?
According to the Skin Cancer Foundation, “The eyelid region is one of the most common sites for non-melanoma skin cancers; skin cancers of the eyelid account for five to ten percent of all skin cancers.” 95% of these tumors are basal cell carcinomas or squamous cell carcinomas. In most cases, these malignant lesions of the eyelid are slow to grow and spread, however they can cause significant damage to the delicate tissues of the eyelid and other vital ocular structures if left untreated for too long. Also of concern is the rising incidence of melanoma, which is the 6th most common cancer in men and the 7th most common in women.
All malignant tumors must be removed to prevent continued growth and invasion into adjacent structures. Unfortunately, eyelid tumors are often difficult to detect because they tend to grow under the skin for years before coming to the surface. The most common presenting symptoms for skin cancer on the eyelids include: a firm, raised lump with a lesion in the center on the eyelid; ulceration (sore) of the eyelid; loss of eyelashes (or misdirected eyelashes); brown or pigmented lesion on the eyelid; prominent red vessels leading to a growth on the eyelid; and a stye that does not heal.
Many patients with eyelid lesions can monitor the growths themselves for a period of time, but are strongly encouraged to have the lesion checked by their eye doctor, dermatologist, or primary care physician. Lesions considered to be most suspicious will characteristically appear scaly, will tend to crack and bleed, and can also grow or change in size and appearance over time. It is always best to have any new lesions evaluated by a specialist to ensure that it is properly monitored or treated if necessary.
Once diagnosed with an eyelid skin cancer, how is it treated?
Basal cell carcinomas and squamous cell carcinomas involving the eyelid are usually treated with microscopically controlled surgery (Mohs micrographic surgery). Mohs surgery is the most effective treatment for these types of skin cancers due to the tissue-sparing nature of the procedure and high cure rates. The five year cure rates are 99 percent for basal cell carcinoma and 98 percent for squamous cell carcinoma. Also, because the minimum amount of tissue necessary is removed, one can achieve the best cosmetic result and maximally preserve function.
How do we prevent eyelid cancer?
Often people will not apply sunscreen/sunblock to the eyelids because of the irritation it causes when it is inadvertently rubbed into the eye. However, if judiciously placed, this can be avoided. For optimal protection, a physical blocker containing zinc oxide or titanium dioxide, and/or chemical blockers such as avobenzone, oxybenzone or MexorylTM should be used. Additionally, epidemiologic data suggest an important way to prevent eyelid cancers is by wearing photoprotective eyeglasses and sunglasses. The eyewear must absorb most UVA and UVB rays, thus blocking 99-100 percent of UV radiation. Use of hats is also a smart way to prevent exposure of the eyelids to harmful radiation.
Kristina Price, M.D.
Medical Director of OPAL Aesthetics