Broadly classified, eyelid tumors can be categories into the following types: benign, inflammatory, vascular, benign epithelial, pre-malignant, common viral and other. These cysts and lesions are described below.
- These include epidermoid cysts, dermoid cysts, sweat ductal cysts and epidermal inclusion cysts. As they are benign, they are easily treatable, though the treatment option for each varies.
- While technically these are not tumors, they must be borne in mind when making a diagnosis of cancer. Lesions include hordoleum (stye), chalazion and parasitic infections.
- Styes often need antibiotics and surgical drainage, chalazion benefits from simple observation and hot compresses along with gentle massage, while parasitic infections may possibly need anti-parasitic medication.
- Hemangiomas are vascular lesions that can mimic eye tumors. They are subcategorized as capillary hemangiomas, cavernous hemangiomas, and lymphangiomas.
- They are often seen in infants and children. If found, they need fairly urgent treatment as they can have an impact on vision and lead to in blindness.
- Treatments include steroids (administered as ointment or injection), laser photocoagulation and surgical excision.
Benign epithelial lesions
- These include squamous papillomas, seborrhoeic keratosis, inverted follicular keratosis and keratoacanthoma. Squamous papillomas appear round or pedunculated and have a smooth surface.
- They can be removed surgically or in some cases interferon might be used. Interferons are a group of signaling proteins made and released by host cells in response to the presence of several viruses. In a typical scenario, a virus-infected cell will release interferons causing nearby cells to heighten their anti-viral defenses.
- Seborrhoeic keratosis is often monitored for a change in shape or size before any treatment is considered. Biopsies can confirm their benign nature.
- A number of different eyelid lesions might become cancerous. They include actinic keratosis, leukoplakia, xeroderma pigmentosum and radiation dermatosis.
- Actinic keratosis occurs in sun-exposed areas and appears like a white, scaly lesion. Excision biopsy aids diagnosis.
Common viral lesions
- Include molluscum contagiosum, verruca vulgaris, herpes simplex and herpes zoster. Molluscum contagiosum is seen in individuals with low immunity, and can cause conjunctivitis.
- They are treated with cryotherapy or excision. Herpes simplex and zoster are treated with antiviral agents.
These include xanthelasma, nevi and caruncular tumors. Most are benign and require simple treatments. Xanthalesma is associated with high cholesterol levels in the blood. Nevi need excision if they change size or shape.
When to Biopsy
There are a number of conditions which might lead to an investigative biopsy:
- skin growth that increases in size
- mole or birthmark with irregular border and changes in size, thickness or texture
- 6 mm large lesion which appears after age 20 and is pigmented
- sore spot that fails to heal
At Idaho Eyelid and Facial Plastic Surgery, we may remove the tumor and have a pathologist check the tissue margins (“frozen section”) to be sure the tumor is completely removed. Alternatively, a dermatologic surgeon may possibly excise the tumor in a special way (“Mohs technique”) to ensure total removal. Once the tumor has been completely removed, reconstructive surgery is usually necessary. Reconstructive surgery is performed to make a new eyelid or repair the defect.
Reconstructive surgery is a particular area of expertise at Idaho Eyelid and Facial Plastic Surgery. The goal is to reconstruct the eyelid so that it functions suitably, protects the eye, preserves vision, and has a satisfactory cosmetic appearance. The patient must keep in mind that any form of therapy for eyelid skin cancer will leave a scar. However, an effort is always made to minimize scarring and obtain optimal cosmetic results. After surgery, the healing process may possibly take six months to one year. Once the wound has healed, follow-up with your physician is necessary to be sure that the skin cancer does not recur. Should there be development of a new cancer, it can then be detected early and treated promptly.