Is a lump on the eyelid cancer?

Introduction

The skin of the eyelids is the thinnest and most delicate on the body, and it is readily damaged by sun exposure. The eyelid area is also one of the most prevalent locations for skin malignancies, accounting for 5-10% of all skin cancers.1,2 90% of these tumours are basal cell carcinomas, a kind of skin cancer that grows slowly and does not spread to other parts of the body. Squamous cell and sebaceous gland carcinomas, as well as malignant melanoma, account for the remaining 10%.2 These cancers are more aggressive than basal cell carcinoma and have the potential to spread to neighbouring lymph nodes and other regions of the body. The lower eyelid is the most prevalent location for malignancy, accounting for more than half of all eyelid malignancies. Cancers are less common in the upper eyelid and brow, the inner corner of the eye, and, in rare cases, the outside corner.

Symptoms of Eyelid Cancer

Lumps caused by eyelid cancer may be red, brown, flesh-coloured, or black in hue. They may spread, alter in appearance, or have difficulty healing correctly.3 A hump that is smooth, glossy, and waxy, or firm and red, a sore that is bleeding, crusty, or scabbed flat, a flesh-coloured or brown lesion that looks like a scar, a scaly and rough red or brown skin patch flat area with a scaly surface that itches or is painful are all common signs of eyelid cancer.4 

Other signs of eyelid cancer include: 

  • Loss of eyelashes
  • Swelling or thickness of the eyelid
  • Persistent infections of the eyelid
  • Unhealed stye

Types of Cancer

Cancer develops when healthy cells begin to alter and expand uncontrollably, generating a mass known as a tumour. A tumour might be malignant or non-cancerous (benign). A malignant tumour is one that may develop and spread to other regions of the body. A benign tumour is one that can develop but does not spread.4

Eyelid cancer is a catch-all phrase for any kind of cancer that develops on or in the eyelid.4 It is classified as an epithelial tumour since it is located on the skin's surface. A sebaceous (fat) gland, sweat gland, or apocrine gland, which is a kind of sweat gland, may give rise to an eyelid tumour.5

Basal Cell Carcinoma

Basal cells are spherical cells found underneath the squamous cells (flat, scale-like cells) in the lower epidermis. This layer of skin is responsible for around 80% of all skin malignancies, and it is directly tied to sun exposure.4 The most frequent kind of eyelid cancer is basal cell carcinoma. It generally arises in the lower lid and is more common in those with light or pale complexion.6

Squamous Cell Carcinoma

The top layer of the epidermis is mostly made up of squamous cells. This layer is where between 10% to 30% of all skin malignancies develop. Sun exposure is frequently the cause of many skin malignancies. They may also form on skin that has been burnt, chemically injured, or exposed to X-rays. Squamous cell carcinoma is far less frequent than basal cell carcinoma, but it is more aggressive and may spread to neighbouring tissues more quickly.6

Sebaceous Carcinoma

Sebaceous carcinoma is the second most prevalent kind of eyelid cancer, mostly affecting middle-aged to older persons.6 It might begin with meibomian glands, which are eyelid glands that secrete a fatty substance that lubricates the eyelids. Less commonly, it begins in the Zeis glands, which are the sebaceous glands at the base of the eyelashes. Sebaceous carcinoma is a kind of aggressive cancer that usually appears on the upper eyelid and is linked to radiation exposure, Bowen's illness, and Muir-Torre syndrome.7 A big sebaceous carcinoma or one that returns after therapy may need surgical removal of the eye.

Melanoma 

The epidermis's lowest layer includes dispersed cells called melanocytes, which create the melanin that provides skin colour. Melanoma is the most dangerous of the three forms of skin cancer because it begins in melanocytes.8

Other Causes of Lumps on Eyelid

Eyelid lumps may be caused by various medical illnesses, the most of which are not significant.

Sties

A stye is a tiny, red, and painful lump that appears near your lashes or beneath your eyelid.9 The lump may have the appearance of a pimple and be sensitive to the touch. The majority of sties are caused by an infection caused by a clogged oil gland. They may enlarge and affect the whole eyelid at times. It is more prone to develop around the border of the eye, where the eyelashes touch the eyelid. Children are more prone to illness. 

A stye on the outside of the eyelid might remain for many days before it breaks and cures.9 Some styes heal on their own, while others need medical attention. If your stye gets really severe or does not heal, you should consult a doctor.9

Blepharitis

Eyelid inflammation (Blepharitis) is a skin disorder characterised by swelling of the eyelids and eyelashes.10 Blepharitis is often caused by bacteria and other skin disorders.10 These follicles on the lids' edges contain oil glands. These oil glands may become blocked or inflamed, causing various eyelid problems. Patients with blepharitis are more prone to develop sties. Washing eyes and lashes may often help reduce blepharitis. To manage symptoms, patients may also wish to use a warm compress.10 Alternatively, taking antibiotics or attempting another sort of therapy.

Chalazion

A chalazion is a tiny, swollen lump that occurs on the upper eyelid.11  It is typically painless. This ailment, also known as a meibomian cyst, is caused by a blocked meibomian or oil gland. When a chalazion swells in size, it may push on your eye and impair your eyesight. It is frequently tough to tell the difference between a chalazion and a stye. Chalazions are less painful than styes and form farther back on the eyelid. They seldom cause the whole eyelid to enlarge.

A chalazion may form on either the upper or lower eyelid. After a few weeks, many will recover on their own. However, if your symptoms are severe or do not go away, you should see a doctor. 

Xanthelasma

Xanthelasma is a skin disorder that arises when a soft, yellowish fatty deposit accumulates under the skin's surface.12 A xanthelasma palpebra is a kind of xanthoma that often develops on the eyelids. It might resemble a yellow or orange lump with distinct edges. You may have multiple lumps, and they may form clusters in certain circumstances. It is not hazardous, although it may be a sign of possible heart problems in rare circumstances.

Diagnosis

In addition to a physical examination, the following tests may be performed to identify eyelid cancer. Not all tests will be administered to every individual. 

Biopsy

Because basal cell and squamous cell cancers seldom spread to other regions of the body, a biopsy is often all that is required to assess the extent of malignancy.13 A biopsy is the removal of a tiny sample of tissue for microscopic examination. Other tests are informative on whether cancer is present, but a biopsy can give a definitive diagnosis. The sort of biopsy used will be determined by the location of the malignancy. The doctor removes the worrisome tissue using procedures that assess the thickness of the malignancy and its margins during this surgery, which is conducted under local or general anaesthesia. The margins are the areas of healthy tissue that surround the lesion. A pathologist examines the material taken during the biopsy. A pathologist is a medical professional who specialises in interpreting laboratory tests and assessing cells, tissues, and organs to identify the illness. The quantity of healthy tissue removed from surrounding the malignancy is proportional to its thickness. If the whole growth is removed, further therapy beyond the biopsy may not be required. 

Computed Tomography (CT)

A CT scan uses an X-ray scanner to take a series of pictures that are then used to generate a three-dimensional image of the interior of the body.14 A computer combines these pictures to provide a thorough cross-sectional depiction of any anomalies or malignancies. A CT scan may also be used to determine the size of the tumour. To improve picture resolution, a specific dye known as a contrast medium is sometimes administered before the scan. This dye may be injected into a patient's vein or given to them in the form of a tablet to ingest. 

Magnetic Resonance Imaging (MRI)

An MRI produces detailed pictures of the body by using magnetic fields rather than X-rays.15 MRI may also be used to determine the size of a tumour. To provide a crisper image, a special dye known as a contrast medium is administered before the scan. This dye may be injected into a patient's vein or given to them in the form of a tablet to ingest. 

Positron Emission Tomography (PET)

A PET scan is a technique for creating images of organs and tissues inside the body.16 A radioactive sugar compound is put into the patient's body in modest amounts. This sugar molecule is absorbed by the cells that use the most energy. Cancer absorbs more radioactive stuff because it aggressively uses energy. The material is then detected by a scanner, which produces pictures of the interior of the body. 

Ultrasound: An ultrasound creates an image of the interior organs by using sound waves.17

The extent, or stage, of cancer, will be determined by the doctor in order to plan therapy.18 The stage is determined by how thick or massive the tumour is, as well as if there is evidence that the disease has spread.18 Sometimes a patient's lymph nodes are removed to see whether the cancer has spread. Other procedures include blood sample analysis and diagnostic scans of the liver, bones, and brain.18

Treatment 

The main therapy for eyelid cancer is surgery. The surgeon will remove the lesion from eyelids and restore the remaining skin. To eliminate eyelid cancers, two popular surgical procedures are used: 

Both treatments involve doctors removing the tumour and a small amount of skin surrounding it in thin layers. As each layer is removed, they look for malignancy cells. 

Other used therapeutic treatments include: 

  • Radiation – another therapy option that may be employed when cancer cells are killed with high-energy X-rays
  • Chemotherapy or targeted therapy,  following surgery 
    • Topical chemotherapy in the form of eye drops is occasionally advised
    • If having basal cell carcinoma, the specialist may also suggest using a topical cream, named imiquimod21 
  • Cryotherapy – use of extreme cold to freeze and remove abnormal tissue, especially in cancer22

Summary 

Avoiding extended sun exposure is the most effective strategy to prevent eyelid cancer. Try to wear a hat, sunglasses, and protective clothes while out in the sun. Also, if you are outdoors for an extended amount of time, use sunscreen to protect the skin. No smoking is another strategy to prevent eyelid cancer. The same is for staying away from alcohol as well as maintaining a modest level of tension (e.g. via exercise).

Consult a doctor if the eyelid lump develops, bleeds, ulcerates, or does not heal properly. If lumps cause discomfort about the risk of eyelid cancer, it is always a good idea to schedule an appointment with a healthcare specialist. 

If having a lump on the eyelid, it is vital to recognise that it might be caused by a variety of things other than cancer. It could probably be just a harmless lump which will naturally and gradually go away on its own.

References

  1. https://www.cancer.gov/publications/dictionaries/cancer-terms/def/malignancy [Internet]. 2011 [cited 2022 Jul 20]. Available from: https://www.cancer.gov/publications/dictionaries/cancer-terms/def/malignancy.
  2. Eyelid Cancer | Columbia Ophthalmology [Internet]. [cited 2022 Jul 20]. Available from: https://www.columbiaeye.org/eye-library/eyelid-cancer.
  3. Eyelid Cancer - Symptoms and Signs. Cancer.Net [Internet]. 2012 [cited 2022 Jul 20]. Available from: https://www.cancer.net/cancer-types/eyelid-cancer/symptoms-and-signs.
  4. Eyelid Cancer - Overview. Cancer.Net [Internet]. 2015 [cited 2022 Jul 20]. Available from: https://www.cancer.net/cancer-types/eyelid-cancer/overview.
  5. https://www.cancer.gov/publications/dictionaries/cancer-terms/def/apocrine-gland [Internet]. 2011 [cited 2022 Jul 20]. Available from: https://www.cancer.gov/publications/dictionaries/cancer-terms/def/apocrine-gland.
  6. Skin Cancer (Non-Melanoma). Cancer.Net [Internet]. 2014 [cited 2022 Jul 20]. Available from: https://www.cancer.net/cancer-types/skin-cancer-non-melanoma.
  7. Lynch Syndrome. Cancer.Net [Internet]. 2012 [cited 2022 Jul 20]. Available from: https://www.cancer.net/cancer-types/lynch-syndrome.
  8. Melanoma. Cancer.Net [Internet]. 2014 [cited 2022 Jul 20]. Available from: https://www.cancer.net/cancer-types/melanoma.
  9. Fort Lauderdale Eye Institute [Internet]. What is an External Eyelid Stye?; [cited 2022 Jul 20]. Available from: https://flei.com/external-eyelid-stye/.
  10. Blepharitis - Eye Disorders. MSD Manual Professional Edition [Internet]. [cited 2022 Jul 20]. Available from: https://www.msdmanuals.com/professional/eye-disorders/eyelid-and-lacrimal-disorders/blepharitis.
  11. Chalazion and Hordeolum (Stye) - Eye Disorders. MSD Manual Professional Edition [Internet]. [cited 2022 Jul 20]. Available from: https://www.msdmanuals.com/en-jp/professional/eye-disorders/eyelid-and-lacrimal-disorders/chalazion-and-hordeolum-stye.
  12. What is xanthelasma? American Academy of Ophthalmology [Internet]. 2021 [cited 2022 Jul 20]. Available from: https://www.aao.org/eye-health/diseases/what-is-xanthelasma.
  13. Biopsy. Cancer.Net [Internet]. 2013 [cited 2022 Jul 20]. Available from: https://www.cancer.net/navigating-cancer-care/diagnosing-cancer/tests-and-procedures/biopsy.
  14. Computed Tomography (CT) Scan. Cancer.Net [Internet]. 2012 [cited 2022 Jul 20]. Available from: https://www.cancer.net/navigating-cancer-care/diagnosing-cancer/tests-and-procedures/computed-tomography-ct-scan.
  15. Magnetic Resonance Imaging (MRI). Cancer.Net [Internet]. 2011 [cited 2022 Jul 20]. Available from: https://www.cancer.net/navigating-cancer-care/diagnosing-cancer/tests-and-procedures/magnetic-resonance-imaging-mri.
  16. Positron Emission Tomography and Computed Tomography (PET-CT) Scans. Cancer.Net [Internet]. 2012 [cited 2022 Jul 20]. Available from: https://www.cancer.net/navigating-cancer-care/diagnosing-cancer/tests-and-procedures/positron-emission-tomography-and-computed-tomography-pet-ct-scans.
  17. Ultrasound. Cancer.Net [Internet]. 2011 [cited 2022 Jul 20]. Available from: https://www.cancer.net/navigating-cancer-care/diagnosing-cancer/tests-and-procedures/ultrasound.
  18. Eyelid Cancer - Diagnosis. Cancer.Net [Internet]. 2012 [cited 2022 Jul 20]. Available from: https://www.cancer.net/cancer-types/eyelid-cancer/diagnosis.
  19. Etzkorn JR, Alam M. What Is Mohs Surgery? JAMA Dermatol [Internet]. 2020 [cited 2022 Jul 20]; 156(6):716. Available from: https://jamanetwork.com/journals/jamadermatology/fullarticle/2764796.
  20. Chalfin J, Putterman AM. Frozen section control in the surgery of basal cell carcinoma of the eyelid. Am J Ophthalmol. 1979; 87(6):802–9.
  21. Imiquimod cream (Aldara) | Cancer information | Cancer Research UK [Internet]. [cited 2022 Jul 20]. Available from: https://www.cancerresearchuk.org/about-cancer/cancer-in-general/treatment/cancer-drugs/drugs/imiquimod.
  22. Cryotherapy: Uses, Procedure, Risks & Benefits. Cleveland Clinic [Internet]. [cited 2022 Jul 20]. Available from: https://my.clevelandclinic.org/health/treatments/21099-cryotherapy.

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Sara Maria Majernikova

Bachelor of Science - BSc, Biomedical Sciences: Drug Mechanisms, UCL (University College London)
Experienced as a Research Intern at Department of Health Psychology and Methodology Research, Faculty of Medicine, Laboratory Intern at Department of Medical Biology, Faculty Medicine Biomedical Sciences Research Intern and Pharmacology Research Intern.

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