What Is Eyelid Cancer?

Eyelid cancer is a type of tumor that most commonly involves the skin or glands of the eyelid. The most common eyelid tumor types are basal cell carcinoma and squamous cell carcinoma. Other less common eyelid tumor types are sebaceous carcinoma, Merkel cell carcinoma, and melanoma. Eyelid cancer is usually treated with surgery.

Eyelid Cancer Statistics

About 85% to 95% of eyelid cancers in non-Asian countries are basal cell skin cancers. An estimated 70% of these cases occur in the lower eyelid, but they can also occur in the inner corner of the eye, the upper lids, and the outer corner of the eye. Basal cell carcinoma is diagnosed most often in adults and rarely occurs in children. It almost never spreads to other parts of the body.

Other types of eyelid cancer are much less common. Squamous cell skin cancer and melanoma make up 5% and less than 1% of all eyelid cancer, respectively.

Bump on eyelid may be eyelid cancer if it persists
​Pridannikov / iStock / Getty Images

Types of Eyelid Cancer

The most common types of cancer occurring on the eyelid are basal cell carcinoma, sebaceous carcinoma, squamous cell carcinoma, and melanoma.

Basal Cell Carcinoma

Under the squamous cells (flat, scale-like cells) in the lower epidermis are round cells known as basal cells. About 80% of skin cancers arise from this layer of the skin, and they are directly related to exposure to the sun.

Basal cell carcinoma, the most common type of eyelid cancer, usually appears in the lower lid and occurs 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, which are glands of the eyelids that discharge a fatty secretion that lubricates the eyelids. Less frequently, it starts from glands of Zeis, the 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. These skin cancers are linked to sun exposure, and they 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 its color. Melanoma starts in melanocytes, and it is the most serious of the three skin cancer types.

Merkel Cell Carcinoma

This is a rare, but aggressive, cancer that starts in the eyelid's touch receptors. It shows up as a fast-growing, purplish or flesh-colored mass.

Eyelid Cancer or a Stye?

Sebaceous carcinomas are one of the rarest eye cancers and can look like a chalazion (stye) or conjunctivitis (pink eye). In that sebaceous carcinoma can mimic these relatively benign diseases, eye care specialists should be suspicious of this tumor in any patient with persistent conjunctivitis, blepharoconjunctivitis, or chronic/recurrent chalazion.

Therefore, any conjunctivitis or chalazion that is not getting better after three months of observation should be brought to the attention of your doctor.

Stages

Staging is a way of describing where cancer is located, if or where it has spread, and whether it is affecting other parts of the body. Doctors use diagnostic tests to find out 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, which is the 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 of Non-Melanoma Eyelid Carcinoma

One tool that doctors use to describe the stage is the TNM system, which stands for tumor, node, metastasis. Doctors use the results from diagnostic tests and scans to answer these questions:

  • Tumor (T): How large is the primary tumor? Where is it located?
  • Node (N): Has the tumor spread to the lymph nodes? If so, where and how many? 
  • Metastasis (M): Has the cancer metastasized to other parts of the body? If so, where and how much?

The results are combined to determine the stage of cancer for each patient. There are 5 stages: stage 0 (zero) and stages I through IV (1 through 4).

Staging of Melanoma

To determine the stage of a melanoma, the lesion and some surrounding healthy tissue need to be surgically removed and analyzed under a microscope. Doctors use the melanoma’s thickness, measured in millimeters (mm), and other characteristics to help determine the cancer's stage.

Doctors also use results from diagnostic tests to answer these questions about the stage of melanoma:

  • How thick or deep is the original melanoma, often called the primary melanoma or primary tumor?
  • Where is the melanoma located?
  • Has the melanoma spread to the lymph nodes? If so, where and how many?
  • Has the melanoma metastasized to other parts of the body? If so, where and how much?

The results are combined to determine the stage of melanoma for each person. The stages of melanoma include: stage 0 (zero) and stages I through IV (1 through 4).

Eyelid Cancer Symptoms

People with eyelid cancer may observe specific changes to the eyelid or they might not show any symptoms at all. Or, sometimes symptoms may be caused by a medical condition that is not cancer. However, the symptoms listed below should not be ignored.

Tell Your Doctor If

Contact your doctor if you note any of these eyelid symptoms:

  • A change in the appearance of the eyelid skin
  • Swelling of the eyelid
  • Thickening of the eyelid
  • Chronic infection of the eyelid
  • An ulceration on the eyelid that does not heal
  • A spreading, colorless mass on the eyelid 

Causes

Although risk factors often influence the development of cancer, most do not directly cause cancer. However, knowing your risk factors and talking about them with your doctor may help you make more informed lifestyle and healthcare choices.

Exposure to Ultraviolet (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. So do people who spend significant time outside or on a tanning bed, which produces mostly UVA radiation.

People who live in areas with year-round, bright sunlight have a higher risk of developing an eyelid cancer.

Other Risk Factors

Besides UV radiations, these are also risk factors for eyelid cancer:

  • Fair skin: 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.
  • Sex: Rates of skin cancer in white men have increased in recent years.
  • Age: Most basal and squamous cell cancers appear after age 50.
  • History of sunburns or fragile skin: Skin that has been burned, sunburned, or injured from disease has a higher risk for eyelid cancer.
  • Weakened immune system: People with weakened immune systems or those who use certain medications are at higher risk for certain skin cancers.
  • Previous skin cancer: People who have had any form of skin cancer have a higher risk of developing another skin cancer.
  • Precancerous skin conditions: Two types of lesions—actinic keratoses and Bowen's disease—may be linked to the development of squamous cell cancer in some people.

Diagnosis

In addition to a physical examination, one or more of the following tests may be used to diagnose eyelid cancer.

Biopsy

Since 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 is the removal of 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.

If your doctor suspects that cancer has spread beyond the eyelid, then imaging tests may be conducted. They include:

Computed Tomography (CT or CAT) Scan

A CT scan creates a three-dimensional picture of the inside of the body with an S-ray machine. It can also be used to measure a tumor's size.

Magnetic Resonance Imaging (MRI)

An MRI uses magnetic fields, not X-rays, to produce detailed images. Like a CT scan, MRI can also be used to measure a tumor's size.

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 sugar substance is injected into the patient’s body.

This sugar substance is taken up by cells that use the most energy and, since 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 internal organs.

Treatment

People who have been diagnosed with eyelid cancer should not wait to get treatment. The quicker an eyelid tumor can be treated, the smaller the area that is involved and the easier the reconstruction.

If treated early, the success of eyelid cancer surgery is very high.

Surgery is the most common treatment for most cases of eyelid cancer and involves removal of the tumor and some surrounding tissue. It is typically performed by an ophthalmologist. Types of surgery include biopsy, Mohs surgery, cryosurgery, and reconstructive surgery.

Biopsy

As mentioned earlier, a biopsy can often be used as a diagnostic tool as well as a treatment. A surgical biopsy may remove part of the tumor (incisional) or the entire tumor (excisional).

If the tumor is found to be cancerous, and the surgeon has removed a sufficient margin of healthy tissue along with the tumor, an excisional biopsy may be the only treatment needed.

Mohs Surgery

This technique involves removing the visible tumor and small fragments of the edge of where the tumor existed. Each small fragment is examined under a microscope until all cancer is removed.

This procedure is most often used for a larger tumor, a tumor in hard-to-reach place, and for cancer that has come back to the same place. Mohs surgery is increasingly becoming a preferred technique for removing an eyelid tumor.

Cryosurgery

Cryosurgery, also called cryotherapy or cryoablation, uses liquid nitrogen to freeze and kill cells. The skin will later blister and shed off. This procedure will sometimes leave a pale scar, and patients may need more than one freezing procedure.

Reconstructive Surgery

Many patients with eyelid cancer require reconstructive surgery. Reconstructive surgery differs from cosmetic surgery in that it is generally performed to improve eye function, although it may also be done to approximate a normal appearance. Oftentimes, multiple surgeries are done, spread out over a period of time.

Non-Surgical Treatment

In addition to surgery, some patients may require other types of treatment, such as targeted therapy, radiation therapy, and chemotherapy. This depends on the type of cancer, stage and size of the tumor, and whether or not the cancer has spread to the lymph nodes or other organs in the body.

Side Effects of Treatment

There are possible side effects for every cancer treatment, but patients don’t experience the same side effects when given the same treatments for many reasons. That can make it hard to predict exactly how you will feel during treatment.

Before treatment begins, talk with your doctor about possible side effects of each type of treatment you will be receiving. Ask which side effects are most likely to happen, when they are likely to occur, and what can be done to prevent or relieve them.

In some cases of eyelid surgery, the functioning of the eyelid can be affected so that the eye doesn’t close completely. This can cause the eye to become dry or tear. Fortunately, this can be treated with medication.

In addition, recurrence of cancer can happen if the tumor is not removed completely. Many eyelid tumors spread to the adjacent tissue, making it tricky to completely remove them. This is why it is recommended to receive treatment from a doctor who is experienced in eyelid cancer treatment.

During and after treatment, it’s important to tell your health care team about any side effects you experience, even if you feel they are not serious. Side effects that last beyond the treatment period are called long-term side effects.

Future Treatment of Eyelid Cancer

There are some non-surgical alternatives for the treatment of eyelid cancer on the horizon. They include the use of medications, in lotion or pill form, designed to kill cancer cells. Two drugs that are currently available for extensive eyelid cancers are showing promise—vismodegib and sonidegib. They are both used to treat basal cell carcinoma.

Prognosis

In general, basal cell and squamous cell skin cancers are almost always curable, especially if the cancer is found and treated early. Melanoma can also be cured if it is diagnosed and treated in its earliest stages. However, melanoma is more likely to spread to other parts of the body.

Coping

In addition to physical side effects, there may be emotional and social effects as well. Patients and their families are encouraged to share their feelings with a member of their healthcare team who can help with coping strategies, including concerns about managing the cost of cancer care.

A Word From Verywell

A lump or bump on your eyelid is a common occurrence, and most will heal and disappear in a few days. If any unusual eyelid symptom persists or worsens, contact your doctor. Early detection and treatment will bring the best outcome.

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Article Sources
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