Eyelid Cancer

Eyelid cancers refer to the several types of malignant cell growth on the eyelid. Whatever the type, the tumor is graded by the differentiation seen in the cells, and the rate of proliferation. Basal cell carcinomas and squamous cell carcinomas are the most frequent. Cancers which do not belong to these groups are rare but occur with a six-fold increased incidence in elderly white patients.

Types of Eyelid Cancer

The main categories of cancers occurring on the eyelids are:

Basal Cell Carcinoma

This accounts for approximately 85% of all tumors occurring on the eyelid, especially common on the lower eyelid. The eyelids account for 16% of basal cell carcinomas in the body. The condition is more often seen in adults. However, younger people are not exempt from it. Skin exposure to the sun or ultraviolet radiation puts one at a higher risk for this type of skin cancer.

The overwhelming majority of basal cell tumors are noduloulcerative while superficial tumors and infiltrative tumors are significantly less common on the eyelids. Tumors of this type rarely spread to nearby or distant organs, either through blood or the lymph nodes. They are treatable, therefore, with a good prognosis.

Squamous Cell Carcinoma (SCC)

This comprises only 5 out of 100 eyelid tumors, but may follow a precancerous condition. It may be caused by chronic skin damage related to sun exposure. Some common precursors of SCC are Bowen’s disease or actinic keratosis. This type of eyelid cancer is more aggressive than basal cell tumors, and metastasis is more common. Spread occurs to the eye socket (local spread), to the local lymph nodes, or to distant organs. If caught early and excised completely, the patients have a good prognosis.  Lifelong follow-up is required because of the relatively high risk of recurrence or of new tumors.

Sebaceous Gland Carcinoma (SGC)

This type of cancer arises from the sebaceous glands in the eyelid - these produce the fatty substance called sebum to lubricate the eyelid skin. It also accounts for less than 5% of eyelid tumors, but is more likely to occur in older people, and especially in older women. The most common site is the upper eyelid because of the large number of Meibomian glands here. It may behave aggressively, and its multifocal nature in some cases makes it a challenge to treat conservatively. Recurrence rates, as well as metastasis rates, are higher with this form of eyelid cancer. It is often diagnosed late because it mimics more benign conditions such as a chalazion or blepharitis.

Malignant Melanoma

This tumor arises from the melanocytes of the skin, and uncommonly occurs on the eyelids (in less than 1 in 100 patients).

B-cell Lymphomas

Several lymphomas may appear first as primary eyelid tumors, but are extremely rare.

Symptoms and Signs

A tumor of the eyelid may appear to be a mild inflammation of the eyelids, called blepharitis. In some patients, the eyelids in the affected site may fall out.

Diagnosis and Treatment

Eyelid tumors are diagnosed based on their clinical features and an excisional biopsy. The tumor is removed and sent for pathologic examination under a microscope.

Surgical Methods

Surgical Excision

This is the most commonly implemented surgical method. It involves the removal of a wide margin of healthy tissue. Since basal cell carcinomas are mostly indolent, they respond well to this form of therapy. In patients who are not fit for surgery of this type, cryotherapy or irradiation is used. These are, however, associated with higher recurrence rates.

Mohs Surgery

This is a specialized conservative form of tumor excision which involves microdissection of the eyelid layer by layer. At each step the excised tissue is examined by a pathologist so as to detect the point at which excision may be stopped. It is available only at some centers.

Curettage and Electrodissection

This is suitable for some small and superficial basal cell carcinomas of the eyelid. Heat is delivered through an electrode to cauterize cancerous tissue and arrest bleeding at the same time. The necrotic tissue is then curetted.

Orbital Exenteration

This refers to the complete removal of all the contents of the orbit if a tumor spreads into the eye socket.

Non-surgical Methods

Non-surgical methods to deal with eyelid cancer include the following:


This is a form of tissue removal by freezing it using liquid nitrogen or other sources of intense cold. It is followed by higher recurrence rates compared with adequate surgical excision.

Eyelid Irradiation

This is used to remove recurrent tumors or tumors which extend throughout the eyelid. It is also suitable for those tumors whose excision would leave too large a defect. Sick or frail patients may also be considered fit for irradiation instead of surgical excision. It is also used postoperatively in patients with SCC and perineural spread. When radiation is used as exclusive therapy, it is associated with higher recurrence rates.

Laser Removal

This is sometimes used to remove small cancers.

Surface Chemotherapy

This involves the application of chemotherapeutic drugs on the eyelid tumor is rarely used.

Eyelid Reconstruction

This may be required if there is a cosmetic defect in the eye as a result of the surgery.


Further Reading

Last Updated: Jan 2, 2023

Dr. Liji Thomas

Written by

Dr. Liji Thomas

Dr. Liji Thomas is an OB-GYN, who graduated from the Government Medical College, University of Calicut, Kerala, in 2001. Liji practiced as a full-time consultant in obstetrics/gynecology in a private hospital for a few years following her graduation. She has counseled hundreds of patients facing issues from pregnancy-related problems and infertility, and has been in charge of over 2,000 deliveries, striving always to achieve a normal delivery rather than operative.


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  1. Reem Sheikh Muhammad Reem Sheikh Muhammad U.A.E. says:

    Dear Doctor
    This is Reem Ahmed and I like to explain briefly and send the medical report of my brother, Ayman Ahmed, who is under treatment as he has advanced extranodal NK/T cell non-Hodgkin lymphoma nasal type with CNS and testicular involvement. His case was discussed in the Tumor Board and he was planned to be started on SMILE Protocol with intrathecal chemotherapy and this to be followed by high-dose therapy/autologous stem cell transplantation if he achieved rmission to chemotherapy. He tolerated his chemotherapy fairly well with remarkable clinical evidence of disease regression as noticed by disappearance   of oral cavity ulcers and skin lesions. At the time of starting his fourh and last cycle 3of chemotherapy he started to have progressive worsening of lesion at the right eye. There was no clinical finfing elsewhere. He was assessed by Ophthalmology with finding of vitritis with multiple whilish lesions  in the retina.Repeated assessment with orbits MRI and brain MRI showed findings consistent with bilateral lymphomatous infiltration of the posterior globe with secondary right retinal detachment and increased enhancement in the internal auditory canal with leptomeningeal infiltration. He went for surgery where he had vitrectomy and multiple biopsieswere taken and it showed evidence of lymphoma as well as cytology from the vitreous fluid by flow cytometry was positive for lymphoma. Repeated assessment showed negative bone marrow piopsy. We discussed again in the Tumor abroad an Ayman was planned to have radiotherapy where he was started on emergency-based radiotherapy on 14 of July 2017. We are seeking your recommendation what can be done. So far we have some options.(Medical report is available, kindly we need email address to send it)
    1- if his PET scan is negative we will consider to go for stem cell mobilization/collection with high-dose cytarabine followed by BEAM conditioning and autologous stem cell transplantation.
    2- HLA tissue typing for patient and his three siblings is pending. Allogenic stem cell transplantion is a considered option despite the logistic issues where he is not eligible to do it in our center and it might be difficult for him to go abroad in early time.
    3- Pralatrex is available in our center and considered to be alternative option.
    4- Novel agents like using PDI inhibitors also discussed based on recent encouraging results in ongoing clinical trials. What is available is Nivolumab and this option also could be considered in the future.
    Thanks alot for your time. Medical report is available.

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