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Cancers of the Eyelid

Basal cell carcinoma: More than 90% of eyelid cancers are basal cell carcinomas (cancer) of the skin. The lower eyelids are involved in more than 70% of cases, followed by the corner of the eye, upper eyelid and the side corner of the eye.

This type of eye cancer can cause significant damage to the eyelid. It can recur (come back) to the same area or nearby if the entire tumor is not removed. The tumors usually do not spread to lymph nodes or distant organs.

It is very important for an experienced and skilled surgeon to remove this type of eye cancer to have the best chance to preserve the eye and its function. At MD Anderson, our  orbital and oculoplastic surgeons  have remarkable expertise in removing and reconstructing the eyelid using specialized surgical reconstructive techniques. Reconstruction of the eyelid tissue is critical to preserving vision, maintaining comfort in the eye, and restoring appearance and function of the eyelid.

Squamous cell carcinoma: This skin cancer occurs less often on the eyelid than basal cell carcinoma, but it is more aggressive. It can spread to nearby lymph nodes and other parts of the body.

The main treatment for this type of eye cancer is surgical removal. Radiation therapy or other treatments may be used in addition to surgery if a large area is affected or if the tumor cannot be fully removed.

As with other eyelid cancers, a reconstructive eye surgeon (oculoplastic surgeon) is key to removal and reconstruction of eyelid squamous cell carcinomas. Our ophthalmic surgeons work closely with experienced dermatopathologists to ensure all the tumor is removed before the eyelid is reconstructed.

Melanoma: This type of skin cancer accounts for about 1% of eyelid cancers. It is a potentially life-threatening type of skin cancer that can affect the eyelid skin or the conjunctiva.  

MD Anderson’s ophthalmic surgeons pioneered sentinel lymph node biopsy for eyelid and conjunctival melanomas (please link this to our clinical trials site for ophthalmology). This technique enables our doctors to find early metastasis in the nearby lymph nodes that drain an eyelid or conjunctival melanoma. Sentinel lymph node biopsy can help stage melanomas of the eyelid and conjunctiva and often can allow our doctors to offer early interventions that increase your chances for successful treatment.

Sebaceous carcinoma (meibomian gland carcinoma): Also known as sebaceous gland or sebaceous cell carcinoma, this rare type of eye cancer affects the meibomian glands of the eyelids, conjunctiva or other ocular surface structures. These glands normally produce the oily layer of the tear film, the liquid layer that covers the eye.

Sebaceous carcinoma of the eyelid can be mistaken for non-cancerous conditions like a chalazion, a small cyst known as a sty. If a sty does not heal with medical treatment or surgical drainage, a biopsy should be done.

Our surgeons have a high level of experience with this rare eye cancer because a large number of patients are referred to our center. Our doctors were the first to do sentinel lymph node biopsy for eyelid sebaceous carcinomas and are able to find early microscopic metastasis in lymph nodes draining the eyelid cancer and offer early treatments to keep it from becoming more advanced.  

The sebaceous cancer in the eyelid is surgically removed, and the defect in the eyelid is reconstructed with various techniques depending on the size and location of the tumor. Sometimes topical chemotherapy (chemotherapy drops) are used after the surgical area has healed.

Merkel cell carcinoma: This uncommon but aggressive cancer of the eyelid arises from the touch receptors in the skin of the eyelid. The cancer usually shows up as a purplish or flesh-colored mass, and it usually grows rapidly.

The treatment for this type of eye cancer is surgery followed by radiation therapy. The tumor has to be surgically removed with wide margins, and the eyelid is reconstructed. A few weeks later, radiation treatment usually is delivered to the surgical area. Sentinel lymph node biopsy is an important additional procedure to consider at the time of surgical treatment.

In about 30% to 50% of patients, cancer has spread to the lymph nodes and need to be treated either surgically or with radiation therapy. For tumors larger than 20 mm (about an inch), intravenous chemotherapy may be used to prevent recurrences.

If you have been diagnosed with eye cancer, we’re here to help. Call 1-877-632-6789 to make an appointment or request an appointment online.

Why Choose MD Anderson?

  • Latest eye cancer treatments, including specialized surgical techniques to remove cancer but save the eye, proton therapy, targeted therapies, advanced reconstructive surgery for eyelid and orbital cancer
  • Advanced diagnostic techniques including sentinel lymph node biopsy, ultrasound biomicroscopy, confocal biomicroscopy and optical coherence tomography (OCT)
  • Skilled, highly specialized eye surgeons and reconstructive surgeons who have dedicated many years of their career to exclusively treat cancer
  • We treat more eye cancers than most centers
  • Team approach to treating eye cancers
  • Clinical trials of leading-edge treatments for eye cancer

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Eyelid Cancer Staging

(source: American Joint Committee on Cancer)

If you are diagnosed with eye cancer, your doctor will determine the stage of the disease. Staging is a way of classifying how much disease is in the body and where it has spread when it is diagnosed. This information helps your doctor plan the best type of treatment for you. Once the staging classification is determined, it stays the same even if treatment is successful or the cancer spreads.

The most common staging system used for ocular cancers was developed by the American Joint Committee on Cancer (AJCC).  The TNM system is based on three key pieces of information:

  • T describes the size of the primary tumor and/or whether it has invaded nearby structures
  • N describes whether the cancer has spread to nearby (regional) lymph nodes
  • M indicates whether the cancer has metastasized (spread) to other parts of the body (The most common site of eye melanoma spread is the liver)

Numbers or letters appear after T, N and M to provide more details about each of these factors:

  • The numbers 0 through 4 indicate increasing severity
  • The letter X means "cannot be assessed" because the information is not available.

Eyelid cancers are staged as follows:

T categories:

  • TX: Primary tumor cannot be assessed
  • T0: No evidence of primary tumor
  • Tis: Carcinoma in situ
  • T1: Tumor 5 mm or less in greatest dimension; not invading the tarsal plate or eyelid margin
  • T2a: Tumor larger than 5 mm, but not more than 10 mm in greatest dimension, or any tumor that  invades tarsal plate or eyelid margin
  • T2b: Tumor larger than 10 mm, but not more than 20 mm in greatest dimension, or involves full thickness of eyelid
  • T3a: Tumor larger than 20 mm in greatest dimension: or any tumor that invades adjacent ocular or orbital structures, or any tumor with perineural invasion
  • T3b: Tumor complete resection requires nucleation, exenteration or bone resection
  • T4: Tumor not resectable due to extensive invasion of ocular, orbital, craniofacial structures or brain

N categories:

  • NX: Regional lymph nodes cannot be assessed (the regional lymph nodes include preauricular (parotid), submandibular, and cervical)
  • N0 (c): No regional lymph node metastasis, based upon clinical evaluation or imaging
  • N0 (p): No regional lymph node metastasis, based upon lymph node biopsy
  • N1: Regional lymph node metastasis

M categories:

  • M0: No distant metastasis
  • M1: Distant metastasis

Merkel Cell Carcinoma Staging

T categories:

  • TX: Primary tumor cannot be assessed
  • T0: No evidence of primary tumor
  • Tis: In situ primary tumor
  • T1: Less than or equal to 2 cm maximum tumor dimension
  • T2: > 2 cm but less than or equal to 5 cm  maximum tumor dimension
  • T3: > 5cm maximum tumor dimension
  • T4: Primary tumor invades bone, muscle, fascia, or cartilage

N categories:

  • NX: Regional lymph nodes cannot be assessed
  • N0: No regional lymph node metastasis
  • cN0: Nodes negative by clinical exam (no pathologic node exam performed)
  • pN0: Based upon lymph node biopsy
  • N1: Metastasis in regional lymph node(s)
  • N1a: Micrometastasis
  • N1b: macrometastasis
  • N2: in transit metastasis

M categories:

  • M0: No distant metastasis
  • M1: Metastasis beyond regional lymph nodes
  • M1a: Metastasis to skin, subcutaneous tissues or distant lymph nodes
  • M1b: Metastasis to lung
  • M1c: Metastasis to all other visceral sites

Eyelid Melanoma Staging

T categories: 

  • TX: Primary tumor cannot be assessed
  • T0: No evidence of primary tumor
  • Tis: Melanoma in situ
  • T1: Melanomas less than or equal to 1.0 mm in thickness
  • T1a:Without ulceration & mitosis <1/mm2
  • T1b: With ulceration or mitoses > 1/mm2
  • T2: Melanomas 1.01: 2.0 mm
  • T2a: Without ulceration
  • T2b: With ulceration
  • T3: Melanomas 2.01: 4.0 mm
  • T3a: iwthout ulceration
  • T3b: With ulceration
  • T4: Melanomas > 4.00 mm
  • T4a: Without ulceration
  • T4b: With ulceration

N categories: 

  • NX: regional lymph nodes cannot be assessed
  • N0: no regional lymph node metastasis
  • N1: 1 node
  • N1a : Micrometastasis*
  • N1 b: Macrometastasis**
  • N2: 2-3 nodes
  • N2a: Micrometastasis*
  • N2b: Macrometastasis**
  • N2c: in transit met(s)/satellite(s) without metastatic nodes
  • N3 clinical:  ≥ 1 node with in transit met(s)/satellite(s)
  • pN3: 4 or more metastatic nodes, or matted nodes, or in transit met(s)/satellite(s) with metastaic nodes(s)

M categories: 

  • M0: No metastasis
  • M1a: Metastasis to skin, subcutaneous tissues or distant lymph nodes
  • M1b: Metastasis to lung
  • M1c: Metastasis to all other visceral sites or distant metastases to any site combined with an elevated serum LDH

Eyelid Lymphoma Staging

T categories:

  • TX: Lymphoma extent not specified
  • T0: No evidence of lymphoma
  • T1: Lymphoma involving the conjunctiva alone without orbital involvement
  • T1a: Bulbar conjunctive only
  • T1b: Palpebral conjunctiva ± fornix ± caruncle
  • T1c: Extensive conjunctival involvement
  • T2: Lymphoma with orbital involvement ± any conjunctival involvement
  • T2a: Anterior orbital involvement (± conjunctival involvement)
  • T2b: Anterior orbital involvement (± conjunctival + lacrimal involvement)
  • T2c: Posterior orbital involvement (± conjunctival involvement ± anterior involvement ± any extraocular muscle involvement)
  • T2d: Nasolacrimal drainage system involvement (± conjunctival involvement but not including nasopharynx)
  • T3: Lymphoma with pre-septal eyelid involvement (defined above) ± orbital involvement ± conjunctival involvement
  • T4: Orbital adnexal lymphoma extending beyond orbit to adjacent structures such as bone and brain
  • T4a: Involvement of nasopharynx
  • T4b: Osseous involvement (including periosteum)
  • T4c: Involvement of maxillofacial, ethmoidal and/or frontal sinuses
  • T4d: Intracranial spread

N categories:

  • NX: Regional lymph nodes cannot be assessed
  • N0: No evidence of lymph node involvement
  • N1: Involvement of ipsilateral regional lymph nodes
  • N2: Involvement of contralateral or bilateral regional lymph nodes
  • N3: Involvement peripheral lymph nodes not draining ocular adnesal region
  • N4: Involvement of central lymph nodes

M categories:

  • M0: No evidence of involvement of other extranodal sites
  • M1a: Noncontiguous involvement of tissues or organs external to the ocular adnexa
  • M1b: Lymphomatous involvement of the bone marrow
  • M1c: Both M1a and M1b involvement

© 2014 The University of Texas MD Anderson Cancer Center