Like other areas of skin, your eyelids can be damaged by too much exposure to the sun, making them susceptible to skin cancers. Indeed, skin cancer is by far the most common form of cancer, and between 5 and 10 percent of all skin cancers occur on the eyelid.
By far the most common type is basal cell carcinoma, which accounts for 86 to 96 percent of eyelid cancers. Squamous cell carcinoma makes up between 3 and 13 percent. The risk of squamous cell carcinoma may be increasing, however. A study published in the British Journal of Ophthalmologyin 2017 found that the incidence of squamous cell carcinoma of the eyelid has increased by about 2 percent a year since 2000. (Melanoma, the most dangerous form of skin cancer, rarely occurs on eyelids; it accounts for only 1 percent of eyelid cancers.)
Fortunately, most eyelid cancers can be successfully removed surgically. But the sooner they’re detected, the better the outcome. So it’s important to be alert to any unusual changes on your eyelids.
Signs of eyelid cancer
Eyelid cancers, like other skin cancers, are linked to sun exposure. The more time you’ve spent outside without the protection of a hat and sunglasses, the greater your risk. People with fair skin, red or blonde hair, and blue eyes are at increased risk.
Men are also more likely than women to develop eyelid cancers. Smoking increases your risk. And as with most malignancies, the risk of eyelid cancers increases with age. In the recent British study, for example, the risk of squamous cell carcinoma doubled for each decade after people reached 60.
Eyelid cancers can appear on either the upper or the lower lid. Early warning signs can include:
- Any sudden change in the appearance of the eyelid, including a bump, a sore, a spot, or a change in color
- A bump or sore that bleeds or itches
- Swelling or thickening of the eyelid
- Repeated infections of the eyelid
- An ulceration (an area of broken skin) that doesn’t heal
- A spreading, colored mass on the eyelid
- An increase or decrease in pigmentation of the eyelid skin
- Tenderness or pain that doesn’t go away
- Loss of eyelashes in one area
- Eyelashes that grow out at abnormal angles
During an examination, your ophthalmologist or optometrist might detect other signs, including an abnormal increase in small blood vessels in your eyelid.
Protecting Your Vision From UV Rays
It’s just as important to shield your eyelids—and your eyes—from ultraviolet rays as it is your skin. Here’s what you can do.
Treating eyelid cancers
To determine whether a bump or a sore on the eyelid is cancerous, ophthalmologists usually perform a biopsy, which involves removing a very small piece of tissue and testing it for the presence of cancerous cells. The standard treatment for eyelid cancers involves removing the cancerous tissue.
Surgeons typically use a surgical technique called Mohs (named after the doctor who developed it), which is designed to preserve as much healthy tissue as possible. That’s important, since removing a large amount of skin from the eyelid can adversely affect both appearance and eyelid function.
During Mohs procedures, small areas of tissue are removed and tested for malignant cells. If cells at the edge (or margin) are cancerous, surgeons remove additional tissue for testing. The process is continued until no more cancerous cells are found at the margins. Although the procedure is time-consuming, it removes only as much skin as is necessary to eliminate the cancer.
If doctors are concerned that cancer may have spread to nearby tissue, they may recommend topical chemotherapy or targeted radiation therapy after surgery. But in most cases, removing the cancerous area is enough. After a successful Mohs procedure, the recurrence rate for basal cell carcinomas, by far the most common eyelid cancer, is less than 1 percent after five years.
Still, to make sure cancer hasn’t returned, experts usually recommend regular checkups with your ophthalmologist or optometrist for up to five years after surgery.
This article first appeared in the July 2019 issue of UC Berkeley Health After 50.
Also see Protecting Your Aging Eyes.
Published July 02, 2019