Basal cell carcinoma: more then 90% of all malignant eyelid tumors are basal cell carcinoma. It usually presents as a small, firm and raised nodule with an ulcerated center and fine telangiectatic blood vessels. Although these tumors do not metastasize to lymph nodes or distant organs, they can cause extensive local destruction.
Squamous cell carcinoma: although less common than basal cell carcinoma, squamous cell carcinoma is much more aggressive. Most of the time it is locally invasive, but it can metastasize to regional lymph nodes and even produce systemic metastatic cancer. Wide surgical excision of these tumors is the primary treatment. Sometimes when there is extensive involvement or adequate margins are not obtained, radiation therapy or other treatment modalities may be used.
Malignant melanoma: melanoma is a relatively rare cancer of the eyelid and accounts for less then 1% of all eyelid malignancies. The tumor thickness should first be identified via a biopsy to determine the required margin of resection. The thicker the tumor (on biopsy), the higher the likelihood of local recurrence and distant metastasis. Complete surgical excision of these tumors with 5-10 mm clear margins is recommended. At the time of diagnosis, a systemic evaluation should be undertaken to assess distant metastasis. These patients need to be followed closely.
Sebaceous cell carcinoma: this is a rare type of cancer involving the eyelids. These tumors primarily originate from the meibomian glands, sebaceous glands of the eyelids that normally produce the oily layer of the tear film. These tumors can be mistaken for some more benign conditions, such as a chalazion or “sty.”
Any “sty” that does not heal and resolve with medical treatment or surgical drainage should be biopsied to rule out sebaceous cell carcinoma. The treatment consists of surgical excision and long-term monitoring for regional lymph node or distant metastasis.