Eye Cancer

Cancers of the Eyelid

Basal Cell Carcinoma: Over 90% of all cancerous eyelid tumors are basal cell carcinomas (BCCA). BCCA is a cancerous growth of skin tissue, specifically basal cells, and usually appears as small, firm, raised lumps with a lesion in the center. The lower eyelids are involved in over 70% of cases, followed by the corner of the eye, upper eyelid and the side corner of the eye.

This type of cancer can cause significant damage to the affected area, and it can recur (come back) to the same area or nearby if it is removed inadequately. However, these tumors generally do not spread to lymph nodes or distant organs.

Squamous Cell Carcinoma: Although this form of skin cancer occurs less often than basal cell carcinoma, it is more aggressive. It can spread to nearby lymph nodes and other parts of the body. The main treatment of these tumors is surgical removal. Radiation therapy or other treatments may be used if a large area is affected or if the cancerous area cannot be fully removed. Also, it may be used if there are other high-risk features, such as nerve involvement.

Malignant melanoma of the eyelid skin: This type of skin cancer is fairly rare and accounts for about 1% of all eyelid cancers. These lesions are usually brown or pigmented, can grow, and change in size with time, at which point they should be completely removed.

Meibomian Gland Carcinoma: also known as sebaceous gland or “sebaceous cell” carcinoma, this rare type of cancer mainly affects the meibomian glands of the eyelids. These are glands that normally produce the oily layer of the tear film, the liquid layer that covers the eye. Meibomian gland carcinoma, also referred to as sebaceous cell carcinoma, can be mistaken with some non-cancerous conditions like a chalazion, a small cyst more commonly known as a “sty”. If a “sty” does not heal with medical treatment or surgical drainage, a biopsy should be performed to evaluate whether it is meibomian gland carcinoma.

Ocular Melanomas

Uveal Melanoma: A rare cancer that develops within a structure in the eye called the uvea. The uvea contains pigment (color) producing cells called melanocytes. When these cells become cancerous, the cancer is called melanoma. The uvea is divided into three parts: the iris, ciliary body, and the choroid. The most common location for this type of cancer to develop is the choroid (choroidal melanoma), which is the back part of the eye under the retina. 

Individuals may not have any symptoms at the time of diagnosis. Some may experience loss of vision, blurry vision, flashes and floaters (an object in the field of vision).

Conjunctival Melanoma: A rare cancer of the conjunctiva, the mucous membrane lining of the eyelid. While melanoma is most commonly found on the skin, it can also occur inside the eye as well as on the surface of the eye and eyelids.

Conjunctival melanomas usually develop as a pigmented (dark) area on the conjunctiva. The cancer may also arise from a freckle or nevus on the conjunctiva or can appear on healthy tissue.

Uveal Melanoma

Uveal melanoma is usually found during a routine eye exam, when a medical doctor looks inside the eye using a special instrument called an ophthalmoscope. Once uveal melanoma is found, more tests will be done to find out what kind of tumor it is and whether cancer cells have spread to other parts of the body. Additional testing may include:

• Eye ultrasound: sound waves are used to create a picture
• Eye angiogram: contrast material is injected while pictures are taken
• Eye photographs: pictures of the eye
• Computerized Tomography Scan (CT scan): an x-ray and a computer are used to create a detailed, two or three-dimensional picture
• Magnetic resonance imaging (MRI): magnetic fields and radio (sound) waves are used to create computerized images
• Blood tests: blood is drawn and sent to a lab for evaluation

Conjunctival Melanoma

This type of melanoma can be diagnosed with an eye examination. A diagnosis is confirmed by performing a biopsy: removal of cells or tissue from a tumor for testing purposes.

The choice of treatment depends on where the cancer is in the eye, how large the tumor is (tumor dimensions) how far it has spread, and the patient’s general health and age. Not all patients are cured with standard therapy and some standard treatments may have more side effects than others. Some patients may benefit from a combination of therapies. Patients may want to consider participating in a clinical trial and should discuss this option with their doctor.

Treatment options include:

• Observation: small lesions may be monitored by the doctor over months or years
• Laser treatment: a laser is used to kill tumor cells
• Radiation Therapy: radiation is used to kill tumor cells
• Enucleation: in advanced cases, surgery to remove the eye is performed
• Excision: surgical removal of the tumor, leaving the eye intact

Cancers of the Eyelid

Malignant melanoma: Treatment is the same as malignant melanoma in other parts of the skin. Complete surgical removal of these tumors with 5 to 10 millimeter margins is recommended. A biopsy will be performed to determine the tumor thickness and allows the doctor to evaluate how much tissue will need to be removed from the affected area. Thicker tumors have a higher chance of recurring locally and spreading to other parts of the body. The patient will need to have periodic chest X-rays and other lab tests to evaluate whether the cancer has spread to other parts of the body.

Meibomian gland carcinoma: Treatment involves surgical removal of the involved area of the eyelid and conjunctiva. Patients will also be monitored for regional (local) lymph node or distant metastasis. After the cancer is removed, reconstructive surgery can be performed and usually leads to acceptable functional and cosmetic outcomes. This is best done by an ophthalmic plastic surgeon, also known as an oculoplastic surgeon. This type of surgeon is an ophthalmologist (eye doctor) who has special training in plastic surgery of the eyelids, the tissues around the eye, the eye’s duct and drainage system, and the orbital area – the bone cavity behind the eye.

Ocular Melanomas

Conjunctival melanomas: are treated with surgical removal followed by cryotherapy the use of extreme cold to destroy cancer cells. Good vision is often preserved in the affected eye. Sometimes topical chemotherapy is used after surgery to prevent the melanoma from coming back.

Conjunctival melanomas have a tendency to come back locally (on the surface of the eye) and often require removal of the affected areas of the eye or tissue around the eye. Up to 20% of patients may develop regional (local) lymph node involvement, usually in the parotid (salivary gland) and neck area.

Uveal melanomas: Enucleation (removal of the eye leaving the ocular adnexal structures including the extraocular muscles intact) is an option, particularly for larger tumors. Radioactive plaques are also an alternative for small to medium sized tumors. The use of some forms of laser or proton beam therapy may also be indicated in some cases.

It is recommended that patients with uveal melanomas, regardless of their local treatment modality, be monitored frequently to look for evidence of local recurrence or distant metastasis. It is estimated that 20-50% of patients develop distant metastasis (usually to the liver) in their lifetime.

Cancer is a journey that no one needs to take alone. There are many forms of support to help you through every stage: diagnosis, treatment and survivorship. Whether you meet with other cancer survivors like yourself, use complementary therapies or individual coping mechanisms, support is available. Listed below are just some of the ways to find help and hope.

Learn more about patient and family support programs

Support Groups

Getting together with other cancer patients in a support group is a valuable coping tool. Support groups are usually focused on a single disease or topic, such as breast cancer survivors or people coping with life-changing side effects from their cancer or cancer therapy. These groups allow participants to meet others like themselves and seek strength from each other. Most major cities and cancer hospitals offer support groups that meet weekly or monthly. There are also dozens of online support Web sites or message boards for those who may not have access to a traditional meeting. 

Find a support group

Complementary Therapies

Complementary therapies are used in conjunction with cancer treatment, in an effort to reduce treatment side effects, ease depression and anxiety and help cancer patients take their mind off the negative aspects of their situation. Complementary therapies may include mind-body exercises like yoga, Tai Chi and Qi gong; visualization or guided imagery; using art or music as therapy and self-expression, and traditional Eastern medicine such as acupuncture. 

Find complementary therapies at M. D. Anderson

Physical Activity

Staying physically active as much as possible during cancer treatment has many positive benefits. Physical activity stimulates the release of endorphins, a hormone that helps elevate mood, as well as decreasing feelings of fatigue.

Exercises for cancer patients can range from simple stretches done in the bed or chair, to more active pursuits such as walking or light gardening work. However, it’s important not to push yourself too hard. Check with your doctor before attempting any physical activity to make sure you are up to it.

Journaling/Blogging

Many people find it helpful to keep a journal of their cancer treatment experience. It may be as simple as recording symptoms and side effects into a notebook, or may include personal emotions and opinions about what they may be going through. Journals can be private, like a diary, or shared with loved ones and even strangers. 

Increasingly, people are turning to the Internet to share their cancer journey with the world at large and to seek out others with similar experiences. Many cancer patients have begun their own Web log, or “blog” to publicize their battle with cancer. Twitter, a mini-blogging technology that limits posts to 140 characters, has also proven to be a helpful tool for cancer patients to keep friends updated and reach out to others.