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eyelid-cancer

Eyelid Cancer

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What is Eyelid Cancer?

Cancer begins when normal cells change and grow uncontrollably, forming a mass called a tumor. A tumor can be benign (noncancerous) or malignant (cancerous, meaning it can spread to other parts of the body). Eyelid cancer is a general term for a cancer that occurs on or in the eyelid and is broadly categorized as an epithelial (outer surface) tumor. An eyelid tumor can begin from sebaceous (fat), sweat, or apocrine glands (a type of sweat gland). The most common types of cancer occurring on the eyelid are:

             

Basal cell carcinoma. Under the squamous cells (flat, scale-like cells) in the lower epidermis (outer layer of skin) are round cells known as basal cells. About 80% of skin cancers arise from this layer in skin, and they are directly related to exposure to the sun. Basal cell carcinoma is the most common type of eyelid cancer, usually appearing in the lower lid and occurring most often in individuals with fair or pale skin.

Sebaceous carcinoma. Mostly occurring in middle age to older adults, sebaceous carcinoma is the second most common eyelid cancer. It may start from meibomian glands (glands of the eyelids that discharge a fatty secretion that lubricates the eyelids) and, less frequently, glands of Zeis (sebaceous glands at the base of the eyelashes). Sebaceous carcinoma is an aggressive cancer that normally occurs on the upper eyelid and is associated with radiation exposure, Bowen's disease, and Muir-Torre syndrome. A large sebaceous carcinoma, or one that returns after treatment, may require surgical removal of the eye.

Squamous cell carcinoma. Squamous cells make up most of the top layer of the epidermis. Approximately 10% to 30% of skin cancers begin in this layer and usually arise from sun exposure, but may also appear on skin that has been burned, damaged by chemicals, or exposed to x-rays. Squamous cell carcinoma is much less common than basal cell carcinoma, but it behaves more aggressively and can more easily spread to nearby tissues.

Melanoma. The deepest layer of the epidermis contains scattered cells called melanocytes, which produce the melanin that gives skin color. Melanoma starts in melanocytes, and it is the most serious of the three skin cancer types.

Symptoms & Signs

People with eyelid cancer may experience the following symptoms or signs. Sometimes people with eyelid cancer do not show any of these symptoms. Or, these symptoms may be caused by a medical condition that is not cancer. If you are concerned about a symptom or sign on this list, please talk with your doctor.

A change in appearance of the eyelid skin

Swelling of the eyelid

Thickening of the eyelid

Chronic infection of the eyelid

An ulceration (area where skin is broken) on the eyelid that does not heal

A spreading, colored mass on the eyelid

Your doctor will ask you questions about the symptoms you are experiencing to help find out the cause of the problem, called a diagnosis. This may include how long you've been experiencing the symptom(s) and how often.

If cancer is diagnosed, relieving symptoms and side effects remains an important part of cancer care and treatment. This may also be called symptom management, palliative care, or supportive care. Be sure to talk with your health care team about symptoms you experience, including any new symptoms or a change in symptoms.

Risk Factors

A risk factor is anything that increases a person's chance of developing cancer. Although risk factors often influence the development of cancer, most do not directly cause cancer. Some people with several risk factors never develop cancer, while others with no known risk factors do. However, knowing your risk factors and talking about them with your doctor may help you make more informed lifestyle and health care choices.

The following factors can raise a person's risk of developing eyelid cancer:

Exposure to UV radiation. Sunlight includes both ultraviolet A (UVA) and ultraviolet B (UVB) radiation. UVB radiation produces sunburn and plays a role in the development of basal cell carcinoma, squamous cell carcinoma, and melanoma. UVA radiation penetrates the skin more deeply, causing photoaging or wrinkling. The role of UVA radiation in the development of non-melanoma eyelid cancer is suspected, but not certain. People who live in areas with year-round, bright sunlight have a higher risk of developing an eyelid cancer, as do those who spend significant time outside or on a tanning bed (which produces mostly UVA radiation).

Fair skin. Less melanin (pigment) in skin offers less protection against UV radiation. People with light hair and light-colored eyes who have skin that doesn't tan, but instead freckles or burns easily, are more likely to develop eyelid cancer.

Gender. Rates of skin cancer in white men have increased in recent years.

Age. Most basal and squamous cell cancers appear after age 50.

A history of sunburns or fragile skin. Skin that has been burned, sunburned, or injured from disease is at higher risk for eyelid cancer. Squamous cell and basal cell cancers more often occur with repeated, long-term exposure to the sun, while melanoma more often occurs with short-term intense exposure to sun.

Individual history. People with weakened immune systems or those who use certain medications are at higher risk for developing squamous cell and basal cell cancers. People with rare, predisposing genetic conditions such as xeroderma pigmentosum, nevoid basal cell carcinoma syndrome, or albinism are at much higher risk for eyelid cancer.

Previous skin cancer. People who have had any form of skin cancer are at higher risk for developing another skin cancer. For instance, about 35% to 50% of people diagnosed with one basal cell cancer will develop a new cancer within five years.

Precancerous skin conditions. Two types of lesions, known as actinic keratoses (characterized by rough, red or brown, scaly patches on the skin), and Bowen's disease (characterized by a bright red or pink, scaly patches located on previously or presently sun-exposed skin), may be related to the development of squamous cell cancer in some people. Bowen's disease in areas not exposed to the sun may be related to arsenic exposure.

Diagnosis

Doctors use many tests to diagnose cancer and find out if it has metastasized (spread). Some tests may also determine which treatments may be the most effective. For most types of cancer, a biopsy is the only way to make a definitive diagnosis of cancer. If a biopsy is not possible, the doctor may suggest other tests that will help make a diagnosis. Imaging tests may be used to find out whether the cancer has metastasized. Your doctor may consider these factors when choosing a diagnostic test:

Age and medical condition

Type of cancer suspected

Severity of symptoms

Previous test results

In addition to a physical examination, the following tests may be used to diagnose eyelid cancer:

Biopsy. Because basal cell and squamous cell cancers rarely spread to other parts of the body, a biopsy is often the only test needed to determine the extent of cancer. A biopsy removes a small amount of tissue for examination under a microscope. Other tests can suggest that cancer is present, but only a biopsy can make a definite diagnosis. The type of biopsy performed will depend on the location of the cancer. During this procedure, performed under local (numbing) or general anesthetic, the doctor removes the suspicious tissue using techniques that test the thickness of the cancer and its margins (healthy tissue around the lesion). The tissue sample is sent to a pathologist (a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease) who determines if the sample contains cancer and, if so, which type. The amount of normal tissue removed around the cancer depends on its thickness. Further treatment beyond the biopsy may not be necessary if the entire growth is removed. If cancer is present at the edges of the tissue taken for the biopsy, additional treatment  is usually necessary.

Computed tomography (CT or CAT) scan. A CT scan creates a three-dimensional picture of the inside of the body with an x-ray machine. A computer then combines these images into a detailed, cross-sectional view that shows any abnormalities or tumors. Sometimes, a contrast medium (a special dye) is injected into a patient's vein to provide better detail.

Magnetic resonance imaging (MRI). An MRI uses magnetic fields, not x-rays, to produce detailed images of the body. A contrast medium (a special dye) may be injected into a patient's vein to create a clearer picture.

Positron emission tomography (PET) scan. A PET scan is a way to create pictures of organs and tissues inside the body. A small amount of a radioactive substance is injected into a patient's body. This substance is absorbed mainly by organs and tissues that produce the most energy. Because cancer tends to use energy actively, it absorbs more of the radioactive substance. A scanner then detects this substance to produce images of the inside of the body.

Ultrasound. An ultrasound uses sound waves to create a picture of the internal organs.

To plan treatment, the doctor will determine the extent, or stage, of the cancer. The stage depends on how thick or large the tumor is and whether there is evidence that the cancer may have spread. Occasionally, a patient's lymph nodes may be removed to determine if the cancer has metastasized. The doctor may perform other tests, including blood sample analysis, MRI, and diagnostic scans of the liver, bones, and brain.

After these diagnostic tests are done, your doctor will review all of the results with you. If the diagnosis is cancer, these results also help the doctor describe the cancer; this is called staging. 

Stages and Grades

Staging is a way of describing where the cancer is located, if or where it has spread, and whether it is affecting the functions of other organs in the body. Doctors use diagnostic tests to determine the cancer's stage, so staging may not be complete until all tests are finished. Knowing the stage helps the doctor to decide what kind of treatment is best and can help predict a patient's prognosis (chance of recovery). There are different stage descriptions for different types of cancer.

Along with staging, the type of tumor is important for a patient's prognosis. For example, a basal cell carcinoma has a more favorable prognosis than a Merkel cell carcinoma. Staging for eyelid carcinoma includes the following types of tumors:

Basal cell carcinoma

Squamous cell carcinoma

Mucoepidermoid carcinoma

Sebaceous carcinoma

Primary eccrine adenocarcinoma

Primary apocrine adenocarcinoma

Adenoid cystic carcinoma

Merkel cell carcinoma

For eyelid melanoma staging, read the melanoma staging section.

Staging of non-melanoma eyelid carcinoma

One tool that doctors use to describe the stage is the TNM system. This system judges three factors: the tumor itself, the lymph nodes around the tumor, and whether the tumor has spread to other parts of the body. The results are combined to determine the stage of cancer for each person. There are five stages: stage 0 (zero) and stages I through IV (one through four). The stage provides a common way of describing the cancer so doctors can work together to plan the best treatments. Not all doctors may use this staging system for eyelid carcinoma; talk with your doctor for more information about staging.

TNM is an abbreviation for tumor (T), node (N), and metastasis (M). Doctors look at these three factors to determine the stage of cancer:

How large is the primary tumor and where is it located? (Tumor, T)

Has the tumor spread to the lymph nodes? (Node, N)

Has the cancer metastasized to other parts of the body? (Metastasis, M)

Tumor. Using the TNM system, the "T" plus a letter and/or number (0 to 4) is used to describe the stage of eyelid cancer. Some stages are also divided into smaller groups that help describe the tumor in even more detail. This helps the doctor develop the best treatment plan for each patient. Specific tumor stage information is listed below.

TX: The primary tumor cannot be evaluated.

T0 (T plus zero): There is no tumor.

Tis: This refers to carcinoma in situ, which is a tumor that has the potential to invade nearby tissues but hasn't yet.

T1: The tumor is 5 millimeters (mm) or smaller in diameter, or it is not invading the tarsal plate (the supporting structure of the eyelid).

T2a: The tumor is larger than 5 mm but not more than 10 mm in greatest diameter, or it has invaded the tarsal plate.

T2b: The tumor is larger than 10 mm but not more than 20 mm in greatest diameter, or it has spread into the full thickness of the eyelid.

T3a: The tumor is larger than 20 mm in greatest diameter or has spread to nearby parts of the eye.

T3b: The tumor has spread to a point where complete removal of the tumor requires removing the eye and/or adjacent structures.

T4: The tumor cannot be removed with surgery because it has spread extensively.

Node. The “N” in the TNM staging system stands for lymph nodes, the tiny, bean-shaped organs that help fight infection. Lymph nodes near the eyelid are called regional lymph nodes. Lymph nodes in other parts of the body are called distant lymph nodes.

NX: The regional lymph nodes cannot be evaluated.

N0 (N plus zero): There is no regional lymph node metastasis.

N1: There is regional lymph node metastasis.

Distant metastasis. The “M” in the TNM system indicates whether the cancer has spread from the eyelid to other parts of the body.

MX: Distant metastasis cannot be evaluated.

M0 (M plus zero): There is no distant metastasis.

M1: There is metastasis to other parts of the body.

Cancer stage grouping

Doctors assign the stage of the cancer by combining the T, N, and M classifications.

Stage 0: This is carcinoma in situ, meaning the tumor has the potential to be an invasive cancer, but it hasn't become one yet (Tis, N0, M0).

Stage IA: The tumor is 5 mm or smaller in diameter or has not invaded the tarsal plate (the supporting structure of the eyelid), and the tumor has not spread to the regional lymph nodes or to other areas in the body (T1, N0, M0).

Stage IB: The tumor is larger than 5 mm but not more than 10 mm in greatest diameter, or it has invaded the tarsal plate. The tumor has not spread to the regional lymph nodes or to other areas in the body (T2a, N0, M0).

Stage IC: The tumor is between 10 mm and 20 mm in greatest diameter or has spread into the full thickness of the eyelid, but it has not spread to the regional lymph nodes or to other areas in the body (T2b, N0, M0).

Stage II: The tumor is larger than 20 mm in greatest diameter or has spread to nearby parts of the eye, but it has not spread to the regional lymph nodes or to other areas of the body. (T3a, N0, M0).

Stage IIIA: The tumor is large enough or has spread enough so that the surgeon will need to remove the eye and nearby structures to get rid of the tumor, but it has not spread to the regional lymph nodes or to other areas of the body (T3b, N0, M0).

Stage IIIB: The tumor is of any size and has spread to the regional lymph nodes, but not to other areas of the body (any T, N1, M0).

Stage IIIC: The tumor has spread outside of the eye, with or without spread to the regional lymph nodes, and cannot be surgically removed due to extensive invasion in structures near the eye. The tumor has not spread to distant parts of the body (T4, any N, M0).

Stage IV: A tumor of any size has spread outside of the eye to distant areas of the body (any T, any N, M1).

Histopathology and grading

Histology describes how closely the cancer cells resemble normal tissue under a microscope. A tumor's grade is described using the letter G and a number.

GX: The tumor grade cannot be identified.

G1: Describes cells that look more like normal tissue cells (well differentiated).

G2: Describes cells that look somewhat different from normal cells (moderately differentiated).

G3: Describes tumor cells that look very much unlike normal cells (poorly differentiated).

G4: The tumor cells barely resemble normal cells (undifferentiated).

Recurrent: Recurrent cancer is cancer that comes back after treatment. It may return in the eye or another part of the body. If there is a recurrence, the cancer may need to be staged again (called re-staging) using the system above.

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