Search

Eyelid Basal Cell Carcinoma - diagnosis & treatment

What is eyelid basal cell carcinoma?


Eyelid basal cell carcinoma is one of the malignant eyelid tumours. It is a skin cancer. Around the eye it is known as periocular basal cell carcinoma (BCC). It is more common in older patients on the lower eyelid although it can appear around the nose in the area known as the medial canthus, the upper eyelid or anywhere on the skin. Commonly it is known as a rodent ulcer. It is a slow growing tumour that rarely spreads to the lymph nodes or other parts of the body. With increased sun exposure and an increasing older population the incidence of BCC is about 1%.


There are different clinical variants of BCC including:

Nodular

Nodular bcc is the most common accounting for 70% of cases and usually develops on the skin of the head. It presents as pearly nodules on the skin that are raised. Fine blood vessels known as telangiectasia are found around it and on its surface. It can develop into an ulcerative of cystic type if left. Larger nodules can have a central ulcer known as ulcer rodens.

Cystic

Cystic BCC has cystic areas of different sizes within the tumour when looked at under the microscope.

Morpheaform (Sclerdermiform)

Morpheaform type BCC tends to have a slightly shiny surface. It can be flat and not raised like the nodular type with borders that are not well defined.

Infiltrated

Infiltrative BCC tends to be flat and white with poorly defined borders. It can invade the local nerves and give a sensation of numbness or sensitivity on the affected area.

Micronodular

Elevated and flat tumours can be microndular BCC. They rarely develop ulcers and have a yellow-whitish colour. These are more common on the skin of the back.

Superficial

These are flat and reddish superificial BCC's. They tend to occur on the skin of the body with a pearl shape.

Pigment

Pigment BCC can occur within other eyelid bcc like nodular, microdular and superficial tumours. They have a dark brown to black colour and may look similar to another skin cancer called malignant melanoma.



What does basal cell carcinoma look like on the eyelid?


Classically a basal cell carcinoma looks like an elevated nodule which can be reddish in colour. It can have a central ulcer and fine vessels known as telangiectasia surrounding it and on its surface. They are slow growing and rarely spread. Some darker or more whitish tumours can also be BCC's.



Can basal cell carcinoma spread to the eye?


Basal cell carcinomas hardly ever spread to the eye or other parts of the body. If left they can grow and spread around the eye which is why it is important to get your eyelid lump checked out early.



What are the symptoms of eyelid cancer?

  • A lump on the eyelid that is growing or spreading

  • Loss of eyelashes around a lump on the eyelid margin

  • A non healing ulcer on the eyelid

  • An infection of the eyelid that does not settle

  • Swelling of the eyelid that persists

  • Thickening of the eyelid

  • A change in the eyelid appearance



Is eyelid cancer common?


Around 90% of eyelid cancers are basal cell carcinoma (BCC). 70% of these are on the lower lid. In terms of skin cancer the eyelid is a common place where they are found.



Can you die from eyelid cancer?


It is rare to die from a BCC unless it is left untreated. Of the eyelid malignancies, malignant melanoma is the most serious that you can die from followed by squamous cell carcinoma as these tumours have the ability to spread. Sebaceous gland carcinoma and Merkel cell carcinoma are also malignant tumours of the periocular region that can spread and be fatal.



How do you get eyelid cancer?


Eyelid cancers or malignant eyelid tumours tend to arise from sun exposure and UV light from tanning beds. This is the greatest risk factor. They can also appear if the skin has been damaged by chemicals, burned or by X-rays, Some people have a tendency to develop eyelid cancers if they have a family history of them or have other medical conditions such as Muir Torre Syndrome or orcin Goltz syndrome which puts them at higher risk.



How is basal cell carcinoma of the eyelid treated?


Periocular bcc is best treated with surgical excision. The aim to to remove the tumour completely. A punch biopsy under local anaesthetic may be done first to see what the eyelid tumour is. Treatment options depend on the type and extent of the tumour found on clinical examination.


Micrographic surgery is performed by a MOHs surgeon. This is where fine sections of the tumour are removed and examined until no more tumour cells remain. Mohs' micrographic surgery is most commonly used for eyelid cancers and is performed int he operating room under a local anaesthetic. Once the tumour is completely removed an oculoplastic surgeon performs reconstructive surgery to close the area where the tumour was removed.

Another surgical technique used is an excisions biopsy. This is where the tumour is removed with a margin of skin and the area is then closed. It is used when mohs surgery is not suitable or when the tumour is small.


For patients who are unable to have surgery ointments that can alter the immune system on the tumour can be applied such as Imiquimod. This agent is also used to treat another tumour called actinic keratosis.

Radiotherapy can also be applied to a tumour if surgery is not a possibility. Photodynamic therapy is an older treatment that is also an option.

All non surgical treatments have a higher recurrence rate of BCC compared to surgical excision.



What happens if basal cell carcinoma is left untreated?


If basal cell carcinoma is left untreated they can increase in size, cause disfigurement the face and spread around the eye potentially affecting vision. In rare cases they can then spread to other parts of the body.



What kind of doctor treats eyelid cancer?


The removal of eyelid cancer is usually performed by an oculoplastic surgeon. The clinical diagnosis lis usually by an oculoplastic surgeon and dermatologists who specialise in this.