Basal Cell Carcinoma
The most common type of eyelid cancer is basal cell carcinoma. Most basal cell carcinomas can be removed with surgery. If left untreated, these tumors can grow around the eye and into the orbit, sinuses and brain. Basal cell carcinomas are more commonly found on the lower eyelids and almost never spread to other parts of the body (metastasize).
A basal cell carcinoma anterior to the medial canthus: Note the pearly margins and the central crater.
Patients with basal cell carcinomas most commonly notice a reddish nodule slowly forming on their eyelid. The tumor is most commonly found on the lower eyelid, followed by the medial canthus (toward the nose) and can occur on the upper eyelid. Eyelash loss (around the tumor) suggests that a tumor is malignant.
Less commonly, basal cell cancers can be pigmented or present without any nodule at all. When the tumor does not make a nodule and grows within the eyelid, it can induce pulling of the eyelid (away from the eye). These cases (morpheaform variant) are much more difficult to treat because its edges are harder to define.
Though small tumors can be photographed and followed for evidence of growth (prior to biopsy); once your eye cancer specialist suspects basal cell carcinoma, most eye cancer specialists will suggest a simple wedge eyelid biopsy. This specimen is sent to the pathologist to confirm the diagnosis prior to complete removal of the tumor.
Wedge biopsies can be performed in the doctor's office, or in the operating room prior to definitive treatment.
Once the diagnosis is confirmed by the pathologist, complete excision under frozen section control or Moh's Technique will be recommended. Both techniques require that the surgeon continue to remove the tumor until the margins (edges) are negative (free of tumor). Unlike most areas of skin, the eyelids are a complex functional apparatus that requires special reconstruction techniques.
Most basal cell carcinomas can be cured when they are small. Unfortunately, some patients choose to ignore or deny the existence of these tumors. Those patients allow their tumor to invade behind the eye and become difficult or impossible to remove. In these cases radiation and chemotherapy may be offered to control or destroy the tumor.
This is a sun related cancer. Dr. Finger suggests, "Think of sunglasses as sunblock for your eyes" TM