MENUBEFORE & AFTERPATIENT REVIEWSMENUBEFORE & AFTERPATIENT REVIEWS
Eyelid tumors are abnormal growths that develop on the skin of the eyelids. The term “tumor” can sound alarming, but it is important to remember that not all eyelid tumors are cancerous—about 80% are benign. The term “tumor” simply refers to an unusual growth, while its nature (benign or malignant) is determined through microscopic examination of a tissue sample.
Although most eyelid tumors are benign (non-cancerous),some can be malignant (cancerous) and require urgent medical attention. Understanding the types, causes, and treatment options for eyelid tumors is crucial for protecting eye health and overall well-being.
The exact cause of eyelid tumors is not always clear, but several factors can contribute to their development:
Eyelid tumors are generally divided into two main categories: benign (non-cancerous) and malignant (cancerous).
These are non-cancerous growths that do not spread to other parts of the body. Common types include:
Chalazion: Also known as a stye, chalazia are swellings that occur due to the blockage of an oil gland in the eyelid. They can be painless or cause severe pain in some cases. Often mistaken for infections, these lumps consist of hardened oils and surrounding inflammation, without any microbial or viral infection. They are not contagious but may appear as multiple lumps if several glands are affected simultaneously or consecutively. Chalazia are more common in individuals with underlying eyelid conditions such as meibomitis or when the immune system is weakened/stressed. They can occur at any age. Treatment mainly involves warm compresses to soften the hardened oils and omega-3 supplements. Additionally, topical or oral antibiotics like erythromycin or tetracycline may be used to regulate oil oxidation.
Papilloma: Papillomas are small, wart-like, skin-colored growths that may be pedunculated or flat. Some are associated with HPV, which can cause them to spread. It is important to distinguish them from lesions that have the potential to become malignant.
Nevus (Mole): Typically harmless, pigmented lesions that require monitoring for changes. Some may start without pigment or lose their pigment over time. Rapidly growing, bleeding, ulcerated, or multi-colored nevi should be biopsied for pathological examination. Contrary to popular belief, simply cutting a small mole does not make it cancerous. While the malignancy potential of simple, small moles is low, they should be monitored by an experienced ophthalmologist.
Xanthelasma: Yellowish plaques formed due to fat accumulation under the skin, often associated with high cholesterol. However, about 50% of patients with xanthelasma do not have elevated cholesterol. The main issue is the leakage and accumulation of cholesterol molecules under the skin due to abnormal or permeable vessels in the eyelid. Treatments include surgical removal, laser/plasma-based ablation, or chemical peeling. It is important to remove both the skin and the underlying damaged tissue containing the vessels to prevent recurrence.
Epidermal Inclusion Cysts: These common eyelid cysts originate from keratin in the outermost layer of the skin, which becomes trapped in an enlarged pore, forming a cyst with a surrounding capsule. These cysts may discharge like pimples but refill quickly; they must be surgically removed intact with the entire capsule to prevent recurrence.
Hidrocystoma: Fluid-filled cysts that arise from sweat glands, seen as either a single growing cyst or multiple small cysts. Surgical removal of the entire cyst without rupturing it is the preferred treatment.
Syringoma: Often misdiagnosed, these small, firm, multiple lesions originate from overgrown sweat glands. They usually begin around ages 10–20 as one or two small lumps and gradually increase in number and size over the years. The most effective treatment is removal using a plasma device.
These are cancerous growths that can spread if left untreated. The most common types include:
The most common malignant eyelid tumor, usually caused by sun exposure. It has a characteristic appearance with pearl-like raised edges and a central depressed area. These tumors do not metastasize but grow slowly. However, if untreated, they can damage surrounding tissues and the eye itself. The slow growth often leads patients to overlook the condition, resulting in late-stage diagnoses. Early treatment is much easier and prevents recurrence, whereas delayed treatment may require more extensive tissue removal and reconstructive surgery, potentially affecting vision and the eye.
Less common but more aggressive than basal cell carcinoma, SCC has the potential to spread to other areas if not treated early. These cancers are more frequently seen in UV-damaged skin, previously healed wounds, or burn scars and can develop from actinic keratosis, which presents as red, scaly lesions. Typically affecting fair-skinned individuals with light-colored eyes, SCC initially appears as persistently scaly, itchy, red patches that gradually enlarge. It has a high risk of spreading through the lymphatic system, blood vessels, or along nerves, making an oncological evaluation necessary upon diagnosis. Surgical removal should be planned urgently to prevent metastasis.
A highly aggressive tumor originating from the oil glands of the eyelid. It grows rapidly and is the most common eyelid cancer in India; however, it is fortunately rare in our country. In its early stages, it can be mistaken for a chalazion, leading to delays in diagnosis and treatment. It has a high potential for metastasis and is sometimes associated with gastrointestinal cancers. Diagnosis requires evaluation by an experienced ophthalmologist or oculoplastic surgeon. Recurring chalazions in the same location or unilateral eyelid margin disease should raise suspicion, and an appropriate biopsy is crucial. Due to its infiltrative nature, multiple biopsy samples should be taken, and extensive tissue removal is often necessary.
A rare but serious type of skin cancer that can also develop on the eyelid. It may arise independently or from pre-existing suspicious nevi or precursor pigmented lesions called lentigo maligna. Nearly half of these tumors are amelanotic, meaning they appear skin-colored rather than pigmented. They often present as raised, irregularly bordered lesions with multiple colors and rapid growth. A deep biopsy is essential, and treatment should not be delayed. Once a certain depth is reached, the tumor has a high risk of metastasizing and becoming life-threatening.
Eyelid tumors can present with various symptoms, including:
If you notice any of these symptoms, consult an ophthalmologist with expertise in oculoplastic surgery for a comprehensive evaluation.
The diagnosis of eyelid tumors typically involves a clinical examination, and sometimes a biopsy to determine whether the growth is benign or malignant. Imaging tests may be used to assess the spread of the tumor. Treatment options depend on the type, size, location, and whether the tumor is benign or malignant. Common treatment options include:
For malignant tumors, the most common approach is to ensure complete removal of the tumor. In suspicious cases, a small sample of the tumor may be taken for biopsy, providing valuable information regarding the size of the surgery and the need for additional treatment afterward. If a tumor is identified as malignant, it is necessary to remove 3-5mm of healthy-looking tissue surrounding the tumor, as cancer cells often spread beyond what is visible. Once the cancerous tissue is completely removed and the tissue margins are confirmed to be clean, your surgeon will ensure both functional and aesthetic outcomes with appropriate reconstruction techniques. Post-surgery, close monitoring for recurrence and the possibility of new tumors in other areas is crucial.
Freezing the tumor to destroy abnormal cells was widely used years ago but is no longer a commonly used method.
Used when surgery is not possible or in cases of recurrence for certain malignant tumors. While it may provide effective improvement in basal cell carcinoma, recurrence is almost inevitable when used alone, so it should not be preferred as a first-line treatment unless necessary. In cases where no other alternatives exist, it may be used for temporary therapeutic success.
For some benign tumors, early-stage basal cell carcinoma, or early recurrences, special creams may be prescribed.
In some types of cancer, systemic medications may be used to shrink the tumor or in cases where surgery is no longer possible. The most common drug used in basal cell carcinoma is vismodegib. The use of these systemic drugs, which have side effects, should begin after a detailed evaluation and a committee report.
Although not all eyelid tumors can be prevented, you can reduce your risk by:
If you notice new growths, persistent irritation, or changes in vision on your eyelids, don’t delay seeking medical advice. If you have growing lesions or masses with lost normal skin characteristics, bleeding, or scaling, consult your eye doctor as soon as possible. Early diagnosis and treatment are key to preserving eye health, preventing complications, and achieving the best outcome.
For the diagnosis and surgical treatment of eyelid tumors, it is best to consult ophthalmologists specializing in eyelid disease (oculoplastic surgeons). They will help differentiate between benign and malignant tumors, determine appropriate treatment, and provide surgery that preserves both the health and integrity of the eye, ensuring a safe and close-to-original tissue reconstruction.
The experience of the pathologist evaluating the tissue margins during the removal of malignant tissue, and, if available, a dermatologic surgeon trained in Moh’s surgery, is very useful for both safety and tissue conservation.
Altuğ Çetinkaya, MD, FEBOOphthalmologist Turkey
Türkçe
English