This is actually a bit of an odd story. A while back, my grown-up son decided to get the small lump on his lower eyelid checked out. His doc really didn’t think it was much of anything but decided to remove it. Luckily, he sent the specimen to pathology. It turned out to be a basal cell carcinoma.
Fast forward, about a year later, I find a teensy tiny lump on my lower lid. Even though it seemed unlikely that my son and I would both have basal cell cancers of the lower lid, I decided to get it checked out. The dermatologist I went to was sure it was just a cyst. She took a scalpel and cut it off…but didn’t send the specimen to pathology. Four or five months later, the little lump returned so I went back to her. Again, she didn’t think it was much of anything (an indication of how benign these things look), but she agreed to send me to the ophthalmologist.
Although he initially couldn’t see the lesion even with a slit lamp, once I pointed it out, he also thought it was just a cyst. He tried to drain it with a hypodermic needle but was unable to extract any fluid. So he said, “I can take it off and send to pathology if you like.” I agreed. He numbed it up and cut it out. It healed beautifully in a few days—no visible scar. Well, guess what? The pathology returned a basal cell carcinoma.
Too weird…Like son, like mother?
Facts about skin cancer on the eyelid
Now basal cell carcinomas are nothing to get freaked out about if you stay on top of things, which of course we (both my son and I) will. But I thought I ought to do a bit of investigating about skin cancer on the eyelid. Here is what I learned from the Skin Cancer Foundation:
- The eyelid area is a common area for non-melanoma skin cancers, such as basal cell and squamous cell carcinoma, accounting for about 5-10% of all skin cancers—melanoma, the most serious type of skin cancer, accounts for only a fraction of eyelid cancers.
- Although non-melanoma skin cancers have low rates of spread (metastasis), when they occur around the eye, they can wreak havoc because the skin is thin in this area and the tumor can, therefore, affect nearby tissues, such as the bony orbit or nasal cavities.
- Eyelid cancers can be difficult to recognize because they tend to grow inward, often growing under the skin for years before finally appearing on the surface.
- Even when it appears on the surface of the lid, its appearance may not suggest a cancer. More than 10% of people later proven to have cancer of the eyelid, initially reported only “altered appearance” of the lid, a red spot, or ingrown lashes. Luckily, most people present with a more typical “warning sign,” such as a lump or a sore that doesn’t heal.
- 44% of eyelid cancers, in one study, occurred on the lower eyelid with another 20% in the area of the medial canthus (see graphic).
Although many will have eyelid lumps and bumps removed by standard surgery, the treatment of choice is MOHS Micrographic Surgery (microscopically controlled surgery) because it can best preserve the complex and delicate structures around the eye. Recurrence after standard surgery or radiation treatment is between 5-30% but falls to 2% of less after MOHS surgery.
A major contributor to eyelid cancers, as is true of all other skin cancers, is UV radiation (both UVA and UVB). Prescription eyeglasses and sun glasses with UV protection are important prevention measures as is application of sunscreen (although anyone who has ever gotten sunscreen in their eyes know that this can be irritating at best and painful at worst).
If you find a lump, bump, red spot or sore that won’t heal in the eyelid area, you should make an appointment with a dermatologist or ophthalmologist. If they say, “no big deal,” ask them to cut it off anyway and be sure to say you want it sent to pathology. Is this overreacting…I don’t think so. Eyelid cancers are tricky, risky, and, for the most part, completely curable.
This post was originally published on October 19, 2011. It was updated on 5/7/17.