Identifying malignant eyelid tumors

Malignant eyelid tumors can lead to significant ocular and visual morbidity. They present in varied histologic types. An understanding of the clinical features of common malignant eyelid tumors can be helpful in earlier diagnosis and could lead to less ocular morbidity.

Malignant eyelid lesions often require a biopsy to confirm that diagnosis, and definitive treatment involves surgery and in rare cases adjuvant radiation therapy. Let’s review the typical clinical features of the most common eyelid tumors and briefly discuss their management.

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Clinical evaluation

When evaluating a patient with an eyelid lesion, it is crucial to obtain a detailed history and perform a thorough ophthalmic examination. Important background information from history-taking include any history of previous skin cancer, excessive sun exposure, smoking, previous exposure to radiation therapy, tanning salons, or chronic immunosuppression. The duration of symptoms and signs, whether the lesion is fast or slow growing, and if the lesion is associated with symptoms of bleeding, crusting, or loss of lashes may be relevant.

On examination, careful attention should be given to the size of the lesion and its location on the eyelid, as well as the presence of ulceration, irregular pigmentation, loss of lashes, or any other distortion or destruction of the normal eyelid margin architecture. Evert the upper eyelid to rule out tarsal or palpebral involvement in the upper eyelid-even for a primarily lower eyelid mass.

External photographs of the lesion should be taken during the first exam. Ocular motility should be tested for presence of restriction which may indicate orbital extension of the eyelid lesion. Preauricular, submandibular, and cervical lymph nodes should be carefully palpated in assessing for the presence of nodal metastases.

The most common malignant eyelid lesions include basal cell carcinoma, squamous cell carcinoma, sebaceous cell carcinoma, and melanoma.

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