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Eye cancer

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Eyelid tumours

There are 4 main types of eyelid cancers:

  • basal cell carcinoma (BCC)
    • BCC is the most common type of eyelid tumour, accounting for about 85% of all eyelid tumours. It is also the most common type of cancer that occurs outside the eyeball.
    • BCC of the eyelid usually affects adults, but may also occur in younger people.
    • These tumours are related to sun exposure and are similar to basal cell carcinoma of the skin.
    • BCC most often occurs in the lower eyelid.
  • squamous cell carcinoma (SCC)
    • SCC of the eyelid is uncommon, accounting for about 5% of all eyelid tumours.
    • It can occur from a precancerous condition, such as actinic keratosis or Bowen’s disease.
    • These tumours are also related to sun exposure and are similar to squamous cell carcinoma of the skin.
    • SCC tends to behave more aggressively and is more likely to spread than BCC.
  • sebaceous gland carcinoma (SGC)
    • SGC is cancer of the glands in the eyelid.
    • It is a rare tumour that may account for up to 5% of all eyelid cancers.
    • It occurs more often in women than men and occurs most often in the elderly.
    • These tumours develop most often on the upper eyelid, followed by the lower eyelid and the caruncle.
      • SGC can start in the Meibomian glands, glands of Zeis or the sebaceous glands of the caruncle.
    • SGC is often diagnosed at a later stage because it can mimic benign conditions. It can also grow aggressively.
    • SGC may be multifocal (occurring in more than one place), so they have a tendency to recur after treatment.
  • malignant melanoma
    • Melanoma of the eyelid is very uncommon and accounts for less than 1% of all eyelid cancers.
    • Melanoma of the eyelid is similar to melanoma of the skin of the skin. It is staged and treated the same way as a skin melanoma.

Signs and symptoms

Eyelid tumours can sometimes imitate other eye disorders, such as inflammation of the eyelid (blepharitis). Eyelid tumours can cause loss of eyelashes.

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Grades

The grade of eyelid carcinoma is based on the degree of differentiation of cells and their rate of growth. The grading is the same as squamous cell carcinomas of the conjunctiva and non-melanoma skin cancer.

Stages

Staging is a way of describing or classifying a cancer based on the extent of cancer in the body. The most common staging system for carcinoma of the eyelid is the TNM system. The International Union Against Cancer (UICC) uses the TNM system to describe the extent of many solid tumour cancers.

The following information applies to eyelid carcinomas, including basal cell carcinoma, squamous cell carcinoma and sebaceous gland carcinoma. Melanoma of the eyelid is staged the same as melanoma skin cancer.

TNM

TNM stands for tumour, nodes, metastasis. TNM staging describes:

  • the size of the primary tumour
  • the number and location of any regional lymph nodes that have cancer cells in them
  • whether the cancer has spread or metastasized to another part of the body

Primary tumour (T)

TX

Primary tumour cannot be assessed.

T0

No evidence of primary tumour.

Tis

Carcinoma in situCarcinoma in situA very early stage of cancer in which tumour cells have not yet invaded surrounding tissues..

T1

Tumour is 5 mm (0.2 inches) or less in size and has not spread into the tarsal plate or the eyelid margin.

T2a

Tumour is more than 5 mm, but less than 10 mm (0.4 inches), in size.

or

Any tumour that has spread into the tarsal plate or the eyelid margin.

T2b

Tumour is more than 10 mm, but less than 20 mm (0.8 inches), in size.

or

Tumour involves the full thickness of the eyelid.

T3a

Tumour is more than 20 mm in size.

or

The tumour has spread into nearby (adjacent) structures of the eye or orbit.

or

The tumour has spread into the nerves (perineural invasion).

T3b

Extensive surgery (enucleation, exenteration or removal of the bone [bone resection]) is required to completely remove the tumour.

T4

The tumour cannot be removed by surgery (not resectable) because it has spread extensively into other structures, such as the eye, orbit, craniosacral structures (including bones, nerves, fluids and connective tissues of the cranium and spinal area) or the brain.

Regional lymph nodes (N)

NX

Regional lymph nodes cannot be assessed

N0

No regional lymph node metastasis

N1

Regional lymph node metastasis

Note: The regional lymph nodes include those around the ear (preauricular nodes), lower jaw (submandibular nodes) and neck (cervical nodes).

Distant metastasis (M)

M0

No distant metastasis

M1

Distant metastasis

Stage grouping for eyelid tumours

The UICC further groups the TNM data into the stages listed in the table below.

UICC staging – eyelid tumours
UICC stageTNMExplanation

stage 0

Tis

N0

M0

Carcinoma in situ.

stage IA

T1

N0

M0

The tumour is 5 mm or less in size and has not spread into the tarsal plate or the margin of the eyelid.

The cancer has not spread to any lymph nodes or to other parts of the body.

stage IB

T2a

N0

M0

The tumour is more than 5 mm but less than 10 mm in size.

or

The tumour has spread into the tarsal plate or the eyelid margin.

The cancer has not spread to the lymph nodes or to other parts of the body.

stage IC

T2b

N0

M0

The tumour is more than 10 mm, but less than 20 mm in size or involves the full thickness of the eyelid.

The cancer has not spread to the lymph nodes or to other parts of the body.

stage II

T3a

N0

M0

The tumour is more than 20 mm in size.

or

The tumour has spread to nearby structures of the eye or orbit.

or

The tumour has spread to the nerves (perineural invasion).

The cancer has not spread to the lymph nodes or to other parts of the body.

stage IIIA

T3b

N0

M0

Enucleation, exenteration or removal of the bone is required to completely remove the tumour.

The cancer has not spread to the lymph nodes or to other parts of the body.

stage IIIB

any T

N1

M0

The cancer has spread to nearby lymph nodes, but it has not spread to other parts of the body.

stage IIIC

T4

any N

M0

The tumour cannot be removed with surgery, because it has spread extensively into other structures, such as the eye, orbit, craniosacral structures or the brain. The cancer may or may not have spread to nearby lymph nodes.

The cancer has not spread to other parts of the body.

stage IV

any T

any N

M1

The cancer has spread to other parts of the body.

Recurrent eyelid carcinoma

Recurrent eyelid carcinoma means that the cancer has come back after it has been treated. It may recur in the same location as the original cancer or it may recur in another part of the body (metastatic eyelid carcinoma).

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Prognosis

Basal cell carcinoma (BCC) of the eyelid rarely spreads to lymph nodes or other organs, so the prognosis for this type of tumour is usually very good.

Squamous cell carcinoma (SCC) can be more aggressive than BCC and can spread to the orbit, lymph nodes or other organs. However, the prognosis is good if SCC of the eyelid is detected early and can be completely removed.

The mortality rate (the number of people who die from the disease each year) for sebaceous gland carcinoma of the eyelid is about 5%–10%. However, sebaceous gland tumours are often not diagnosed early and have a high rate of recurrence and spread (metastasis).

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Treatment

The treatment for tumours of the eyelid usually involves surgery.

  • Surgical excision (resection) is done to completely remove the tumour and a small amount of healthy tissue from around the tumour.
  • Mohs surgery may also be used to treat eyelid tumours in certain situations.
    • Mohs surgery is a special surgical method used to remove the eyelid tumour layer by layer.
    • The layers of tissue are examined under a microscope until the tissue is completely free of cancer cells.
    • Only specially trained surgeons perform this surgery, so it may not be available at all treatment centres.
  • Curettage and electrodesiccation can also be used to treat some small, surface (superficial) basal cell carcinomas of the eyelid.
    • Curettage and electrodesiccation is a surgical procedure that uses heat or an electric current to destroy cancerous tissue and control bleeding.
    • The destroyed tissue is then scraped away.
  • If an eyelid tumour has spread into the orbit of the eye, orbital exenteration may be necessary.

If surgery causes a defect of the eyelid, it can be repaired using reconstructive surgery.

Treatment options that may be used instead of surgery include:

  • Cryosurgery may be used for small, well-defined tumours.
  • External beam radiation therapy may be used:
    • instead of surgery, if surgery would affect the person’s appearance
    • for recurrent or extensive eyelid tumours that are difficult to remove or cannot be completely removed by surgery
    • for people who are not well enough to have surgery or other treatments
  • Laser surgery is rarely used but may be an option for some small tumours.
  • Topical chemotherapy is rarely used but may be an option in certain cases.

For more information, go to treatment of basal cell carcinoma and treatment of squamous cell carcinoma.

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