Malignant Eyelid Tumors: The Great Masquerade

Dr. Min Joung Lee, Professor, Department of Ophthalmology, Hallym University Sacred Heart Hospital, Republic of Korea

Dr. Kyung In Woo, Professor, Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Republic of Korea

On behalf of Asia Pacific Society of Ophthalmic Plastic and Reconstructive Surgery

In the realm of ophthalmology, eyelid tumors are a frequent concern. While the majority of these tumors are non-cancerous, it's crucial to recognize that a subset of cases (approximately 15-20%) can present malignancy. Notable malignancies encompass basal cell carcinoma, sebaceous gland carcinoma, squamous cell carcinoma, and malignant melanoma. It's worth noting that the prevalence of these conditions varies across different regions globally. In Western countries, basal cell carcinoma instances are more prevalent, whereas in certain parts of Asia, such as Korea, Japan, China, and India, higher rates of sebaceous gland carcinoma are observed. Several factors contribute to the risk of developing these tumors, including prolonged exposure to ultraviolet (UV) radiation, fair skin, advanced age, smoking, genetic predispositions, prior radiation treatment, and compromised immune systems.

Identifying "red flag signs" that suggest malignancy is important. These signs include ulceration, firmness, irregular eyelid margins, and eyelash loss. Basal cell carcinoma typically emerges as a painless nodule with or without an ulcer. Sebaceous gland carcinoma, derived from lipid glands, can pose diagnostic challenges due to its atypical appearance. Squamous cell carcinoma, resembling basal cell carcinoma, might exhibit scaling. Malignant melanoma, though rare, demands attention for pigmented lesions with irregular borders or changing features. Confirming the diagnosis requires a biopsy. Thorough ophthalmic examinations play a pivotal role, often supplemented by radiological imaging to assess the tumor's extent. The primary treatment approach revolves complete surgical removal of the tumor, followed by eyelid reconstruction. In advanced cases, exenteration followed by radiation therapy might be necessary. In select regions, a targeted oral medication inhibiting abnormal signaling of Hedgehog pathway is available for advanced basal cell carcinoma.

Emphasizing prevention is of utmost importance. Strategies include safeguarding the eyes from sun exposure, discontinuing smoking habits, and promptly investigating any new or unusual lesions. Individuals experiencing recurrent chalazia or unilateral blepharoconjunctivitis should seek evaluation by an ophthalmologist, as these symptoms could indicate sebaceous gland carcinoma. Timely detection significantly enhances the prospects of successful treatment and reconstruction, contributing to favorable functional and cosmetic outcomes. By staying vigilant and collaborating with medical professionals, we can effectively address eyelid tumors and their potential challenges.

Photo acknowledgement: APAO / APSOPRS Eye Care Week public education materials and media kit

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