What is eyelid skin cancer?
Eyelid skin cancer is an abnormal growth of cancerous cells on or within the eyelid. The eyelids are among the most common sites for skin cancer on the face, accounting for roughly five to ten percent of all skin cancers. Because the eyelid is a delicate structure with a complex function, skin cancer in this area requires prompt evaluation and treatment by a specialist with expertise in both cancer removal and eyelid reconstruction.
Most eyelid skin cancers are highly treatable when caught early. The key is recognizing the warning signs and seeking evaluation before the cancer has had the opportunity to grow deeper into the eyelid tissue or spread to surrounding structures.
Types of eyelid skin cancer
Several types of skin cancer can develop on the eyelid. They vary in how they look, how aggressively they behave, and how they are treated:
- Basal cell carcinoma is the most common type of eyelid skin cancer that typically appears as a small, pearly, or waxy bump, often with tiny blood vessels visible on the surface, or as a flat, scar-like lesion. Basal cell carcinoma grows slowly and rarely spreads to other parts of the body, but it can grow deeper into the eyelid and surrounding tissue if left untreated. It most commonly affects the lower eyelid.
- Squamous cell carcinoma is less common than basal cell carcinoma but tends to be more aggressive. It may appear as a scaly, crusted, or ulcerated patch on the eyelid skin and has a higher potential to spread to nearby lymph nodes or other parts of the body if not treated promptly.
- Sebaceous carcinoma is a rare but serious type of eyelid cancer that arises from the oil-producing glands within the eyelid. It most commonly affects the upper eyelid and requires aggressive treatment due to its potential to spread.
- Melanoma of the eyelid is rare but can be life-threatening if not detected and treated early. It may appear as a dark, irregularly shaped lesion on the eyelid skin and requires prompt evaluation and treatment.
What are the symptoms of eyelid skin cancer?
Eyelid skin cancer does not always look the way people expect a cancer to look. Any new or changing growth on the eyelid warrants evaluation, even if it appears small or insignificant. Common signs include:
- A lump, bump, or nodule on the eyelid that does not go away
- A sore or ulceration on the eyelid that does not heal
- Redness, thickening, or crusting of the eyelid skin
- Loss of eyelashes in a specific area, or lashes that do not grow back after falling out
- A change in the shape or position of the eyelid
- Bleeding or oozing from a lesion on the eyelid
- A lesion that looks like a persistent stye or chalazion that does not respond to treatment
Any eyelid lesion that is new, growing, or behaving differently than expected should be evaluated by an oculofacial plastic surgeon.
What causes eyelid skin cancer?
Eyelid skin cancers develop when the DNA within skin cells is damaged, causing them to grow abnormally. The most significant risk factor for the most common types of eyelid skin cancer is long-term exposure to ultraviolet (UV) light from the sun or tanning beds. Additional risk factors include:
- Fair skin, light eyes, or light hair, which offer less natural protection against UV damage
- A history of significant or repeated sunburns
- A personal or family history of skin cancer
- A weakened immune system
- Prolonged exposure to radiation
- Chronic inflammatory skin conditions affecting the eyelid
How is eyelid skin cancer diagnosed?
Diagnosis begins with a thorough clinical examination by your oculofacial plastic surgeon. During this evaluation, your surgeon will:
- Examine the eyelid lesion closely, assessing its size, shape, borders, and appearance
- Review your medical history, including any prior skin cancers and sun exposure history
- Assess the surrounding eyelid tissue, eyelash line, and nearby structures for any signs of involvement
A biopsy is required to confirm the diagnosis. During a biopsy, a small sample of tissue is removed from the lesion and examined under a microscope by a pathologist to determine whether cancer cells are present and, if so, what type.
How is eyelid skin cancer treated?
Treatment depends on the type of cancer, its size and location on the eyelid, and how deeply it has grown into the surrounding tissue. The goal in every case is complete removal of the cancer while preserving as much healthy eyelid tissue as possible and restoring normal eyelid function and appearance.
Mohs micrographic surgery is a specialized technique performed by a dermatologic surgeon in which the cancer is removed one thin layer at a time. After each layer is removed, it is immediately examined under a microscope to check for remaining cancer cells. This process continues until the margins are clear. Mohs surgery is highly effective for basal cell and squamous cell carcinomas of the eyelid and allows the maximum amount of healthy tissue to be preserved. When Mohs surgery is used to remove an eyelid cancer, an oculofacial plastic surgeon performs the eyelid reconstruction following the procedure.
Eyelid reconstruction is an essential part of eyelid skin cancer treatment. Because even small tumors can require the removal of a significant portion of the eyelid, reconstruction is needed to restore the eyelid's ability to close fully, protect the eye's surface, and maintain a natural appearance. Reconstruction techniques vary depending on how much tissue was removed and which part of the eyelid was affected, and may involve local tissue rearrangement, skin grafts, or other reconstructive approaches.
Radiation therapy may be recommended for certain patients who are not candidates for surgery or as an additional treatment following surgical removal in cases of more aggressive tumors.
Had Mohs surgery? Your next step is reconstruction.
Removing the cancer is only half the equation. Even small tumors can require the removal of a significant portion of the eyelid — and without proper reconstruction, that can affect how your eyelid closes, how your eye stays protected, and how you look and feel. Our oculofacial plastic surgeons specialize in restoring eyelid function and appearance after skin cancer excision.
Learn more about eyelid reconstruction after skin care removal.
Eyelid skin cancer is highly treatable when caught early. Call 515.875.9480 to schedule an appointment with a board-certified oculofacial plastic surgeon at The Iowa Clinic.