Skin cancer is common among many races and ethnic groups, but occurs most frequently in fair skinned individuals and those from sunny climates.
Skin cancers can occur on the eyelid skin, on the inner lining of the eyelid, or on the eyeball itself. They are most common on the lower eyelid. Symptoms include a firm, raised area on the eyelid. There is often irritation, including itching, crusting, or bleeding. There may be loss of eyelashes, or a change in the normal eyelid margin. These lesions may be pale colored, reddish, or more darkly pigmented.
Many patients have lumps and bumps on their eyelids. Most of the time, these are benign lesions including skin tags, freckles, keratosis, cysts, and styes. Most of the time, these lesions are soft, longstanding, cause minimal irritation, and the surrounding eyelid is normal in appearance.
An eye exam is the best place to begin when identifying eyelid lesions. If a lesion is suspicious, or its diagnosis is in question, a biopsy can be performed in the office.
If a lesion is a skin cancer, the most common types are basal cell carcinoma, followed by squamous cell carcinoma. Melanoma and sebaceous carcinoma are much less frequent. Treatment involves surgical excision with frozen section control and reconstruction. This is performed in the operating room under twilight anesthesia. The lesion is removed and a pathologist who is present examines the edges under a microscope. Once all the edges are examined and free of cancer, the eyelid can then be repaired as needed at the same time. We also work closely with dermatologic surgeons, Moh’s surgeons, who remove the skin cancer, and we can then repair the defect.
The incidence of skin cancer is on the rise, and sunblock, sunglasses that protect against both UVA and UVB rays, and hats are the best protection from the sun. Luckily, most skin cancers are slow growing, and rarely spread to other parts of the body. They do however, need to be properly diagnosed and removed. Any new or changing eyelid lesions need to be brought to the attention of your doctor.