The eyelid region is one of the commonest sites for skin cancers. The two commonest forms are basal cell carcinomas (also called rodent ulcers) and squamous cell carcinomas which account for 95% of skin tumours around the eyes. Less commonly, skin cancers such as melanoma and sebaceous gland carcinoma are found around the eyes. In the UK there are an average of 48,000 new cases of basal cell carcinoma a year, but this is probably an underestimate, with the true figure being more likely to be between 55,000 to 60,000 cases.
Skin cancers on the eyelids, face and arms are associated with excess exposure to sun light. Fair skinned people develop skin cancers more frequently than darker skinned people. There may also be a hereditary element in the possibility of developing skin cancer.
Basal cell carcinomas and squamous cell carcinomas may appear as a painless nodule or an ulcer that will not heal, with intermittent bleeding and crusting. The normal eyelid structure may be distorted and eyelashes may be missing if the edge of the eyelid is affected. They slowly enlarge and will damage neighbouring structures if not removed. They rarely spread to other parts of the body. By detecting these tumours early, there is a better chance of removing these tumours completely and minimizing the amount of tissue that needs to be removed.
Melanomas form in the pigment producing melanocytes in the skin. Although much less common that basal cell and squamous cell carcinomas they are more serious. Any mole that changes in size, shape, colour, bleeds or becomes sore should be assessed for signs that it has changed into a melanoma.
Sebaceous gland carcinoma develops in the oil glands in the skin of the eyelid. The lid may appear thickened or chronically inflamed. This is another serious form of skin cancer, but is uncommon. Melanomas and sebaceous gland carcinomas can spread to other parts of the body through the blood stream and so early, aggressive treatment is necessary to reduce the chance of spread.
Skin cancers around the eyes are usually removed by surgery. In all cases it is important to remove not only the visible lump but also the roots of the lump which extend to a wider area than the lump itself. The specimen which contains the skin cancer is sent to a pathology laboratory where it can be examined microscopically to make sure that all the cancerous cells have been removed.