Eyelid Tumors - Summary of Benign and Malignant

• Cancer of the eyelid, like any other cancer, can be a worrying thing. Treatments are variable and depend on the type of cancer. In this article, we shall take a brief look at the different kinds of eyelid tumors.
• Broadly classified, eyelid tumors can be of the following types –

Benign Eyelid Lesions

Benign cysts

• These include epidermoid cysts, dermoid cysts, sweat ductal cysts and epidermal inclusion cysts.
• As they are benign, they are easily treatable, though the treatment option for each varies.

Inflammatory lesions

• While technically these are not tumors, they must be borne in mind when making a diagnosis of cancer. Lesions include hordoleum (stye), chalazion and parasitic infections.
• Style often need antibiotics and surgical drainage, chalazion benefits from simple observation and hot compresses if required, along with a gentle massage, while parasitic infections might need anti-parasitic medication.

Vascular lesions 

• Hemangiomas are vascular lesions that can mimic eye tumors. They might be a capillary hemangioma, cavernous hemangioma or a lymphangioma.
• They are often seen in infants and children. If found, it needs fairly urgent treatment as it can have an impact on vision and lead to in blindness.
• Treatments include steroids (administered as a ointment or injection), laser photocoagulation and surgical excision if required.

Benign epithelial lesions

• These include squamous papillomas, seborrhoeic keratosis, inverted follicular keratosis and keratoacanthoma. Squamous papillomas appear round or pedunculated and have a smooth surface.
• They can be removed surgically or in some cases interferon might be used. Seborrhoeic keratosis is often monitored for a change in shape or size before any treatment is considered. They frequently need a biopsy to confirm their benign nature.

Pre-malignant lesions

• A number of different eyelid lesions might become cancerous. They include Actinic keratosis, leukoplakia, Xeroderma pigmentosum and radiation dermatosis.
• Actinic keratosis occurs in sun-exposed areas and appears like a white, scaly lesion. Excision biopsy aids diagnosis.

Viral lesions

• Common viral lesions include molluscum contagiosum, verruca vulgaris , herpes simplex and herpes zoster.
• Molluscum contagiosum is seen in individuals with low immunity, and can cause conjunctivitis. They are treated with cryotherapy or excision. Herpes simplex and zoster are treated with antiviral agents.

Malignant eyelid lesions

• These are the cancerous lesions, and include basal cell carcinoma, squamous cell carcinoma, malignant melanoma and sebaceous gland carcinoma.
• Basal cell carcinoma is the most common eyelid malignancy, and occurs as a small module at the inner aspect of the eye (medial canthus). They are locally invasive and require surgical excision.
• Squamous cell carcinoma is not as common, and appears red and scaly with an ulcer in the center. It is prone to distant spread so must be excised as soon as possible.
• Sebaceous carcinoma is seen in elderly population, and can spread to lymph nodes and distant organs. Radical surgery is often needed. Melanomas are rare and might need excision.

Other Eyelid lesions

These include Xanthelasma, nevi and Caruncular Tumors. Most are benign and require simple treatments. Xanthalesma is associated with high cholesterol levels in the blood. Nevi need excision if they change size or shape

 When to Biopsy

• skin growth that increases in size
• mole or birthmark with irregular border and changes in size, thickness or texture
• 6 mm large lesion which appears after age 20 and is pigmented
• sore spot that fails to heal