These are cancers of the skin which present on the eyelid. There are 4 important ones you should be aware of and they are discussed in this section in order of commonality.
Basal Cell Carcinoma (BCC)
By far the commonest cancer in ophthalmology
Presentation
- Most commonly occurs on lower lid of eye and upper lip of the mouth
- It is a slow-growing lesion and does not typically spread
- The lesion is pearly white with associated telangiectasia
Management
- Surgical resection
- Mohs Micrographic surgery can for used in high-risk cases where the lesion margins are uncertain
Vismodegib is a medication approved for non-resectable cases and works through the Hedgehog pathway. BCC is associated with Ptch/Smo gene mutation in the Hedgehog pathway
Squamous Cell Carcinoma
Associated with HPV and immunocompromise
Pathology
- Aggressive and spreads via lymphatics
- Histology shows epidermal proliferation, atypical keratinocytes, and squamous eddies
Management
- Surgical excision, radiotherapy, chemotherapy
Melanoma
Melanoma is not always pigmented.
Pathology
- Most likely to arise from the choroid inside the eye (highest concentration of melanin)
- Spreads to the liver
- Breslow thickness is the prognostic indicator
Management
- Surgical excision, radiotherapy, chemotherapy
Vemurafenib is a kinase inhibitor with FDA approval for unresectable tumours
Sebaceous Gland Carcinoma
Sebaceous gland carcinoma arises from Meibomian and Zeis glands
Pathology
- Can be misdiagnosed as unilateral blepharitis. Blepharitis is seldom unilateral
- Spreads to lymph nodes and viscera
- Associated with Muir Torre syndrome
Management
- Surgical excision, radiotherapy, chemotherapy
- Prognosis is poor
