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Eyelid Cancer - Overview

Approved by the Lineagotica Editorial Board, 08/2015

Editorial Note: Please note that this section is currently under review and will be updated soon.

ON THIS PAGE: You will find some basic information about this disease and the parts of the body it may affect. This is the first page of Lineagotica’s Guide to Eyelid Cancer. To see other pages, use the menu on the side of your screen. Think of that menu as a roadmap to this full guide.

Overview

Cancer begins when healthy cells change and grow uncontrollably, forming a mass called a tumor. A tumor can be cancerous or benign. A cancerous tumor is malignant, meaning it can grow and spread to other parts of the body. A benign tumor means the tumor can grow but will not spread.

Eyelid cancer is a general term for a cancer that occurs on or in the eyelid. It is broadly categorized as an epithelial tumor, which is on the outer surface. An eyelid tumor can begin from sebaceous (fat), sweat, or apocrine glands, which is a type of sweat gland.

The most common types of cancer occurring on the eyelid are:

  • Basal cell carcinoma. Under the squamous cells (flat, scale-like cells) in the lower epidermis are round cells known as basal cells. About 80% of skin cancers arise from this layer in skin, and they are directly related to exposure to the sun. Basal cell carcinoma is the most common type of eyelid cancer. It usually appears in the lower lid and occurs most often in individuals with fair or pale skin.

  • Sebaceous carcinoma. Mostly occurring in middle age to older adults, sebaceous carcinoma is the second most common eyelid cancer. It may start from meibomian glands, which are glands of the eyelids that discharge a fatty secretion that lubricates the eyelids. Less frequently, it starts from glands of Zeis, the sebaceous glands at the base of the eyelashes. Sebaceous carcinoma is an aggressive cancer that normally occurs on the upper eyelid and is associated with radiation exposure, Bowen’s disease, and Muir-Torre syndrome. A large sebaceous carcinoma or one that returns after treatment may require surgical removal of the eye.

  • Squamous cell carcinoma. Squamous cells make up most of the top layer of the epidermis. Approximately 10% to 30% of skin cancers begin in this layer. These skin cancers usually arise from sun exposure. They may also appear on skin that has been burned, damaged by chemicals, or exposed to x-rays. Squamous cell carcinoma is much less common than basal cell carcinoma, but it behaves more aggressively and can more easily spread to nearby tissues.

  • Melanoma. The deepest layer of the epidermis contains scattered cells called melanocytes, which produce the melanin that gives skin color. Melanoma starts in melanocytes, and it is the most serious of the three skin cancer types.

The rest of this guide focuses on skin cancer, particularly melanoma.

The next section in this guide is Statistics and it helps explain how many people are diagnosed with this disease and general survival rates. Or, use the menu on the side of your screen to choose another section to continue reading this guide.

Eyelid Cancer - Statistics

Approved by the Lineagotica Editorial Board, 08/2015

ON THIS PAGE: You will find information about how common eyelid cancer is. You will also read general information on surviving the disease. Use the menu to see other pages.

Skin cancer is very common in general, and the eyelid is a common place that skin cancer is found. Most eyelid cancers are the basal cell skin cancer type. It is diagnosed most often in adults between 50 and 80 years of age who have fair skin.

Other types of eyelid cancer are much less common. Squamous cell skin cancer and melanoma make up 5% and less than 1% of all eyelid cancer, respectively.

In general, basal cell and squamous cell skin cancer is almost always curable, especially if the cancer is found and treated early. Melanoma is also highly curable if it is diagnosed and treated in its earliest stages. However, melanoma is more likely to spread to other parts of the body.

It is important to remember that statistics for people with eyelid cancer are an estimate. The estimate comes from annual data based on the number of people with this cancer in the United States. Talk with your doctor if you have any questions about this information. Learn more about understanding statistics.

Statistics adapted from Pe’er, Jacob, Pathology of Eyelid Tumors,” Indian Journal of Ophthalmology 2016 Mar; 64(3): 177–190; and Wills Eye Hospital (January 2019).

The next section in this guide is Risk FactorsIt explains what factors may increase the chance of developing eyelid cancer. Use the menu to choose a different section to read in this guide.

Eyelid Cancer - Risk Factors

Approved by the Lineagotica Editorial Board, 08/2015

ON THIS PAGE: You will find out more about the factors that increase the chance of developing this type of cancer. To see other pages, use the menu on the side of your screen.

A risk factor is anything that increases a person’s chance of developing cancer. Although risk factors often influence the development of cancer, most do not directly cause cancer. Some people with several risk factors never develop cancer, while others with no known risk factors do. However, knowing your risk factors and talking about them with your doctor may help you make more informed lifestyle and health care choices.

The following factors can raise a person's risk of developing eyelid cancer:

  • Exposure to UV radiation. Sunlight includes both ultraviolet A (UVA) and ultraviolet B (UVB) radiation. UVB radiation produces sunburn and plays a role in the development of basal cell carcinoma, squamous cell carcinoma, and melanoma. UVA radiation penetrates the skin more deeply, causing photoaging or wrinkling. The role of UVA radiation in the development of non-melanoma eyelid cancer is suspected, but not certain. People who live in areas with year-round, bright sunlight have a higher risk of developing an eyelid cancer. So do people who spend significant time outside or on a tanning bed, which produces mostly UVA radiation.

  • Fair skin. Less melanin (pigment) in skin offers less protection against UV radiation. People with light hair and light-colored eyes who have skin that doesn’t tan, but instead freckles or burns easily, are more likely to develop eyelid cancer.

  • Gender. Rates of skin cancer in white men have increased in recent years.

  • Age. Most basal and squamous cell cancers appear after age 50.

  • A history of sunburns or fragile skin. Skin that has been burned, sunburned, or injured from disease is at higher risk for eyelid cancer. Squamous cell and basal cell cancers more often occur with repeated, long-term exposure to the sun. Melanoma more often occurs with short-term intense exposure to sun.

  • Individual history. People with weakened immune systems or those who use certain medications are at higher risk for developing squamous cell and basal cell cancers. People with rare, predisposing genetic conditions such as xeroderma pigmentosum, nevoid basal cell carcinoma syndrome, or albinism are at much higher risk for eyelid cancer.

  • Previous skin cancer. People who have had any form of skin cancer are at higher risk for developing another skin cancer. For instance, about 35% to 50% of people diagnosed with one basal cell cancer will develop a new cancer within five years.

  • Precancerous skin conditions. Two types of lesions may be related to the development of squamous cell cancer in some people. Actinic keratoses is characterized by rough, red or brown, scaly patches on the skin. Bowen's disease is characterized by bright red or pink, scaly patches located on previously or presently sun-exposed skin. Bowen's disease in areas not exposed to the sun may be related to arsenic exposure.

The next section in this guide is Symptoms and Signs and it explains what body changes or medical problems this disease can cause. Or, use the menu on the side of your screen to choose another section to continue reading this guide. 

Eyelid Cancer - Symptoms and Signs

Approved by the Lineagotica Editorial Board, 08/2015

ON THIS PAGE: You will find out more about body changes and other things that can signal a problem that may need medical care. To see other pages, use the menu on the side of your screen.

People with eyelid cancer may experience the following symptoms or signs. Sometimes people with eyelid cancer do not show any of these symptoms. Or, these symptoms may be caused by a medical condition that is not cancer.

  • A change in appearance of the eyelid skin

  • Swelling of the eyelid

  • Thickening of the eyelid

  • Chronic infection of the eyelid

  • An ulceration (area where skin is broken) on the eyelid that does not heal

  • A spreading, colored mass on the eyelid

If you are concerned about one or more of the symptoms or signs on this list, please talk with your doctor. Your doctor will ask how long and how often you’ve been experiencing the symptom(s), in addition to other questions. This is to help find out the cause of the problem, called a diagnosis.

If cancer is diagnosed, relieving symptoms remains an important part of cancer care and treatment. This may also be called symptom management, palliative care, or supportive care. Be sure to talk with your health care team about symptoms you experience, including any new symptoms or a change in symptoms.

The next section in this guide is Diagnosis and it explains what tests may be needed to learn more about the cause of the symptoms. Or, use the menu on the side of your screen to choose another section to continue reading this guide.  

Eyelid Cancer - Diagnosis

Approved by the Lineagotica Editorial Board, 08/2015

ON THIS PAGE: You will find a list of the common tests, procedures, and scans that doctors can use to find out what’s wrong and identify the cause of the problem. To see other pages, use the menu on the side of your screen.

Doctors use many tests to diagnose cancer and find out if it has spread to another part of the body, called metastasis. Some tests may also determine which treatments may be the most effective. For most types of cancer, a biopsy is the only way to make a definitive diagnosis of cancer.

If a biopsy is not possible, the doctor may suggest other tests that will help make a diagnosis. Imaging tests may be used to find out whether the cancer has spread.

Your doctor may consider these factors when choosing a diagnostic test:

  • Age and medical condition

  • Type of cancer suspected

  • Signs and symptoms

  • Previous test results

In addition to a physical examination, the following tests may be used to diagnose eyelid cancer. Not all tests listed will be used for every person.

  • Biopsy. Because basal cell and squamous cell cancers rarely spread to other parts of the body, a biopsy is often the only test needed to determine the extent of cancer. A biopsy is the removal of a small amount of tissue for examination under a microscope. Other tests can suggest that cancer is present, but only a biopsy can make a definite diagnosis. The type of biopsy performed will depend on the location of the cancer.

    During this procedure, performed under local (numbing) or general anesthetic, the doctor removes the suspicious tissue using techniques that test the thickness of the cancer and its margins. The margins are the healthy tissue around the lesion. The sample removed during the biopsy is analyzed by a pathologist. A pathologist is a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease. The amount of healthy tissue removed around the cancer depends on its thickness. Further treatment beyond the biopsy may not be necessary if the entire growth is removed.

    If cancer is present at the edges of the tissue taken for the biopsy, additional treatment (for example, surgery, radiation therapy, or cryotherapy; see Treatment Options) is usually necessary.

  • Computed tomography (CT or CAT) scan. A CT scan creates a three-dimensional picture of the inside of the body with an x-ray machine. A computer then combines these images into a detailed, cross-sectional view that shows any abnormalities or tumors. A CT scan can also be used to measure the tumor’s size. Sometimes, a special dye called a contrast medium is given before the scan to provide better detail on the image. This dye can be injected into a patient’s vein or given as a pill to swallow.

  • Magnetic resonance imaging (MRI). An MRI uses magnetic fields, not x-rays, to produce detailed images of the body. MRI can also be used to measure the tumor’s size. A special dye called a contrast medium is given before the scan to create a clearer picture. This dye can be injected into a patient’s vein or given as a pill to swallow.

  • Positron emission tomography (PET) scan. A PET scan is a way to create pictures of organs and tissues inside the body. A small amount of a radioactive sugar substance is injected into the patient’s body. This sugar substance is taken up by cells that use the most energy. Because cancer tends to use energy actively, it absorbs more of the radioactive substance. A scanner then detects this substance to produce images of the inside of the body.

  • Ultrasound. An ultrasound uses sound waves to create a picture of the internal organs.

To plan treatment, the doctor will determine the extent, or stage, of the cancer. The stage depends on how thick or large the tumor is and whether there is evidence that the cancer may have spread. Occasionally, a patient’s lymph nodes may be removed to determine if the cancer has metastasized. The doctor may perform other tests, including blood sample analysis, and diagnostic scans of the liver, bones, and brain. Read Stages and Grades for more information.

After diagnostic tests are done, your doctor will review all of the results with you. If the diagnosis is cancer, these results also help the doctor describe the cancer. This is called staging.

The next section in this guide is Stages and Grades, and it explains the system doctors use to describe the extent of the disease. Or, use the menu on the side of your screen to choose another section to continue reading this guide. 

Eyelid Cancer - Stages and Grades

Approved by the Lineagotica Editorial Board, 08/2015

ON THIS PAGE: You will learn about how doctors describe a cancer’s growth or spread. This is called the stage. This section also covers grading, which describes the composition of cells. To see other pages, use the menu on the side of your screen.

Staging is a way of describing where the cancer is located, if or where it has spread, and whether it is affecting other parts of the body. Doctors use diagnostic tests to find out the cancer’s stage, so staging may not be complete until all tests are finished.

Knowing the stage helps the doctor to decide what kind of treatment is best and can help predict a patient’s prognosis, which is the chance of recovery. There are different stage descriptions for different types of cancer.

Along with staging, the type of tumor is important for a patient’s prognosis. For example, a basal cell carcinoma has a more favorable prognosis than a Merkel cell carcinoma. Staging for eyelid carcinoma includes the following types of tumors:

  • Melanoma

  • Basal cell carcinoma

  • Squamous cell carcinoma

  • Mucoepidermoid carcinoma

  • Sebaceous carcinoma

  • Primary eccrine adenocarcinoma

  • Primary apocrine adenocarcinoma

  • Adenoid cystic carcinoma

  • Merkel cell carcinoma

Staging of melanoma of the eyelid

For eyelid melanoma staging, read the main melanoma staging section found on this website.

Staging of non-melanoma eyelid carcinoma

One tool that doctors use to describe the stage is the TNM system. Doctors use the results from diagnostic tests and scans to answer these questions:

  • Tumor (T): How large is the primary tumor? Where is it located?

  • Node (N): Has the tumor spread to the lymph nodes? If so, where and how many?  

  • Metastasis (M): Has the cancer metastasized to other parts of the body? If so, where and how much?

The results are combined to determine the stage of cancer for each person. There are five stages: stage 0 (zero) and stages I through IV (one through four). The stage provides a common way of describing the cancer, so doctors can work together to plan the best treatments.

Here are more details on each part of the TNM system for eyelid cancer:

Tumor (T)

Using the TNM system, the "T" plus a letter and/or number (0 to 4) is used to describe the stage of eyelid cancer. Some stages are also divided into smaller groups that help describe the tumor in even more detail. This helps the doctor develop the best treatment plan for each patient. Specific tumor stage information is listed below.

TX: The primary tumor cannot be evaluated.

T0 (T plus zero): There is no tumor.

Tis: This refers to carcinoma in situ, which is a tumor that has the potential to invade nearby tissues but hasn’t yet.

T1: The tumor is 5 millimeters (mm) or smaller in diameter, or it is not invading the tarsal plate, the supporting structure of the eyelid.

T2a: The tumor is larger than 5 mm but not more than 10 mm in greatest diameter, or it has invaded the tarsal plate.

T2b: The tumor is larger than 10 mm but not more than 20 mm in greatest diameter, or it has spread into the full thickness of the eyelid.

T3a: The tumor is larger than 20 mm in greatest diameter or has spread to nearby parts of the eye.

T3b: The tumor has spread to a point where complete removal of the tumor requires removing the eye and/or adjacent structures.

T4: The tumor cannot be removed with surgery because it has spread extensively.

Node (N)

The “N” in the TNM staging system stands for lymph nodes, the tiny, bean-shaped organs that help fight infection. Lymph nodes near the eyelid are called regional lymph nodes. Lymph nodes in other parts of the body are called distant lymph nodes.

NX: The regional lymph nodes cannot be evaluated.

N0 (N plus zero): There is no regional lymph node metastasis.

N1: There is regional lymph node metastasis.

Metastasis (M)

The “M” in the TNM system indicates whether the cancer has spread from the eyelid to other parts of the body, called distant metastasis.

MX: Distant metastasis cannot be evaluated.

M0 (M plus zero): There is no distant metastasis.

M1: There is metastasis to other parts of the body.

Grade (G)

Doctors also describe this type of cancer by its grade (G), which describes how much cancer cells look like healthy cells when viewed under a microscope. The doctor compares the cancerous tissue with healthy tissue. Healthy tissue usually contains many different types of cells grouped together.

If the cancer looks similar to healthy tissue and contains different cell groupings, it is called differentiated or a low-grade tumor. If the cancerous tissue looks very different from healthy tissue, it is called poorly differentiated or a high-grade tumor. The cancer’s grade may help the doctor predict how quickly the cancer will spread. In general, the lower the tumor’s grade, the better the prognosis.

GX: The tumor grade cannot be identified.

G1: Describes cells that look more like healthy tissue cells (well differentiated).

G2: Describes cells that look somewhat different from healthy cells (moderately differentiated).

G3: Describes tumor cells that look very much unlike healthy cells (poorly differentiated).

G4: The tumor cells barely resemble healthy cells (undifferentiated). 

Cancer stage grouping

Doctors assign the stage of the cancer by combining the T, N, M, and G classifications.

Stage 0: This is carcinoma in situ, meaning the tumor has the potential to be an invasive cancer, but it hasn’t become one yet (Tis, N0, M0).

Stage IA: The tumor is 5 mm or smaller in diameter or has not invaded the tarsal plate (the supporting structure of the eyelid), and the tumor has not spread to the regional lymph nodes or to other areas in the body (T1, N0, M0).

Stage IB: The tumor is larger than 5 mm but not more than 10 mm in greatest diameter, or it has invaded the tarsal plate. The tumor has not spread to the regional lymph nodes or to other areas in the body (T2a, N0, M0).

Stage IC: The tumor is between 10 mm and 20 mm in greatest diameter or has spread into the full thickness of the eyelid, but it has not spread to the regional lymph nodes or to other areas in the body (T2b, N0, M0).

Stage II: The tumor is larger than 20 mm in greatest diameter or has spread to nearby parts of the eye, but it has not spread to the regional lymph nodes or to other areas of the body. (T3a, N0, M0).

Stage IIIA: The tumor is large enough or has spread enough so that the surgeon will need to remove the eye and nearby structures to get rid of the tumor, but it has not spread to the regional lymph nodes or to other areas of the body (T3b, N0, M0).

Stage IIIB: The tumor is of any size and has spread to the regional lymph nodes, but not to other areas of the body (any T, N1, M0).

Stage IIIC: The tumor has spread outside of the eye, with or without spread to the regional lymph nodes, and cannot be surgically removed due to extensive invasion in structures near the eye. The tumor has not spread to distant parts of the body (T4, any N, M0).

Stage IV: A tumor of any size has spread outside of the eye to distant areas of the body (any T, any N, M1).

Recurrent: Recurrent cancer is cancer that has come back after treatment. It may return in the eye or another part of the body. If the cancer does return, there will be another round of tests to learn about the extent of the recurrence. These tests and scans are often similar to those done at the time of the original diagnosis.

Used with permission of the AJCC, Chicago, Illinois. The original source for this material is the AJCC Cancer Staging Manual, Seventh Edition, published by Springer-Verlag New York, www.cancerstaging.org

Information about the cancer’s stage and grade will help the doctor recommend a specific treatment plan. The next section in this guide is Treatment Options. Or, use the menu on the side of your screen to choose another section to continue reading this guide. 

Eyelid Cancer - Treatment Options

Approved by the Lineagotica Editorial Board, 08/2015

ON THIS PAGE: You will learn about the different ways doctors use to treat people with this type of cancer. To see other pages, use the menu on the side of your screen.

This section outlines treatments that are the standard of care (the best known treatments available) for this specific type of cancer. When making treatment plan decisions, patients are also encouraged to consider clinical trials as an option.

A clinical trial is a research study to test a new approaches to treatment to evaluate whether it is safe, effective, and possibly better than the standard treatment. Clinical trials may test such approaches as a new drug, a new combination of standard treatments, or new doses of current therapies. Your doctor can help you review all treatment options. For more information, see the About Clinical Trials and Latest Research sections.

Treatment overview

In cancer care, different types of doctors often work together to create a patient’s overall treatment plan that combines different types of treatments. This is called a multidisciplinary team. Cancer care teams also include a variety of other health care professionals, including physician assistants, oncology nurses, social workers, pharmacists, counselors, dietitians, and others.

For eyelid cancer, this team may include a:

  • Dermatologist, a doctor who specializes in diseases and conditions of the skin

  • Surgeon

  • Radiation oncologist

  • Ophthalmologist, a medical doctor who specializes in diseases and function of the eye

  • Medical oncologist, a doctor who specializes in treating cancer with medication

Patients with eyelid cancer should talk with doctors who have experience treating this type of cancer. These doctors can provide guidance on preserving the function of the eye during treatment and identifying potential problems after treatment.

Patients should have a sense that their doctors have a coordinated plan of care and are communicating effectively with one another. If patients do not feel that the team is communicating effectively with them or each other about the goals of treatment and the plan of care, patients should discuss this with their doctors or seek additional opinions before treatment.

Descriptions of the most common treatment options for eyelid cancer are listed below. Treatment options and recommendations depend on several factors, including the type and stage of cancer, possible side effects, and the patient’s preferences and overall health. Your care plan may also include treatment for symptoms and side effects, an important part of cancer care. Take time to learn about all of your treatment options and be sure to ask questions about things that are unclear. Also, talk about the goals of each treatment with your doctor and what you can expect while receiving the treatment. Learn more about making treatment decisions.

Surgery

Surgery is the removal of the tumor and some surrounding healthy tissue during an operation. Eye surgery is typically performed by an ophthalmologist. Different types of surgical procedures are used depending on the size of the cancer and where it is located. Learn more about the basics of cancer surgery.

Extensive surgery may result in scarring and deformity of the eyelid, enucleation (removal of the eye), and/or may cause problems with tear drainage. Talk with your doctor before surgery about the possible side effects from your surgery, including changes to your vision and appearance, as well as physical and psychological support services available to you for your recovery.

  • Biopsy. A surgical biopsy may remove part of the tumor (incisional) or the entire tumor (excisional). If the tumor is found to be cancerous, and the surgeon has removed a sufficient margin of healthy tissue along with the tumor, an excisional biopsy may be the only treatment needed. See the Diagnosis section for more information about a biopsy for eyelid cancer.

  • Mohs' surgery. This technique involves removing the visible tumor and small fragments of the edge of where the tumor existed. Each small fragment is examined under a microscope until all cancer is removed. This procedure is most often used for a larger tumor, a tumor in hard-to-reach place, and for cancer that has come back to the same place. However, it is increasingly becoming a preferred technique for removing an eyelid tumor. After Mohs’ surgery, a patient may need to undergo reconstructive surgery (see below) by an ophthalmologist or plastic surgeon trained in ocular (eye) reconstructive procedures to retain the function of the eye.

  • Cryosurgery. Cryosurgery, also called cryotherapy or cryoablation, uses liquid nitrogen to freeze and kill cells. The skin will later blister and shed off. This procedure will sometimes leave a pale scar, and patients may need more than one freezing procedure.

  • Reconstructive surgery. Many patients with eyelid cancer require reconstructive surgery. Reconstructive surgery differs from cosmetic surgery in that it is generally performed to improve eye function, although it may also be done to approximate a normal appearance. Oftentimes, multiple surgeries are done, spread out over a period of time. Cosmetic surgery is performed on normal structures for the purpose of appearance. A surgeon may use skin grafts in order to completely reconstruct the eyelid and give patients a normal appearance.

Having an eye removed

Although rare, sometimes it is medically necessary to remove the eye. Because of this visual loss, a person with one eye may have trouble with depth perception. Most people adjust to these differences, with support from the health care team.

Many people worry about what they will look like when they have an eye removed. The cosmetic surgery available today usually yields good cosmetic results. To fill the area left by the missing eye, the person is fitted for a prosthesis (artificial eye). The prosthesis will look and behave almost the same as a natural eye. For example, the artificial eye will move along with the person’s remaining eye, just not as much as a natural eye moves. Family members may be able to tell that the eye is not real, but it is unlikely that strangers will know.

If enucleation is required, talk with your doctor about a prosthesis. It may take many weeks for you to receive the prosthesis. Also, ask about support services that may be available to you to help adjust to the loss of an eye. Learn more about rehabilitation.

Radiation therapy

Radiation therapy is the use of high-energy x-rays or other particles to destroy cancer cells. A doctor who specializes in giving radiation therapy to treat cancer is called a radiation oncologist. The most common type of radiation treatment is called external-beam radiation therapy, which is radiation given from a machine outside the body. A radiation therapy regimen (schedule) usually consists of a specific number of treatments given over a set period of time.

Radiation therapy may be used for a cancer that is hard to treat with surgery, and several treatments may be needed. Treatment side effects may include a rash, dry or discolored skin, fatigue, mild skin reactions, upset stomach, or loose bowel movements. Most side effects go away soon after treatment is finished. However, other side effects, such as those listed below, may show up later.

Treatment for eyelid cancer using radiation therapy is continually improving. Talk with your doctor about the risks and benefits of the different types of radiation therapy. Side effects may include:

  • Cataracts. Cataracts are very common. A cataract is when the lens of the eye becomes cloudy. People with cataracts may have cloudy or foggy vision, have trouble seeing at night, or have problems with glare from the sun or bright lights. If the cataract is causing major problems with a person's eyesight, it may be surgically removed.  

  • Loss of eyelashes and/or a dry eye. Loss of eyelashes and/or a dry eye can occur with radiation therapy. Some treatment options include over-the-counter eye drops, prescription eye drops such as cyclosporine ophthalmic (Restasis), and plugs that can be placed in the tear ducts. Talk with your ophthalmologist about how to help relieve these side effects.

  • Change in lid position. After radiation therapy and/or surgery, the eyelid may roll inward (entropion) or sag outward (ectroption). Either condition may affect eye health and can be repaired with surgery.

  • Radiation keratopathy. Exposure to high energy x-rays to the eyelid can cause a disease of the eye’s cornea, called keratopathy. This can cause damage to the top layer of the eye and damage the cornea.

  • Other common side effects. Other common side effects from radiation therapy include red eye, tearing, and sensitivity to light.

The following side effects are much less common and can cause a loss of vision:

  • Radiation retinopathy. Radiation retinopathy is the development of abnormal blood vessels in the retina, which is the thin-layered structure that lines the eyeball.

  • Radiation optic neuropathy. Radiation optic neuropathy is radiation-induced optic nerve damage.

  • Neovascular glaucoma. Neovascular glaucoma is a painful condition that involves new blood vessels developing and blocking the regular release of fluid from the eye.

If there is significant damage to the eye from radiation therapy, the eye may need to be removed (see above).

Learn more about the basics of radiation therapy.

Chemotherapy

Chemotherapy is the use of drugs to destroy cancer cells, usually by stopping the cancer cells’ ability to grow and divide. For eyelid cancer, chemotherapy is most commonly a topical therapy, meaning it is placed directly on the affected skin. Topical chemotherapy may be prescribed by a medical oncologist, a doctor who specializes in treating cancer with medication, or by an ophthalmologist or dermatologist.

The most common topical chemotherapy is fluorouracil (Efudex). This is a skin cream or solution a patient puts on the affected area. It may be used as an alternative to surgery, especially for patients with a smaller tumor.

The side effects of topical fluorouracil may include pain, burning, itching, dryness, irritation, or swelling where it was applied. Sometimes people experience sensitivity to sunlight and scarring or discoloration of the skin. These side effects usually go away once treatment is finished.

Learn more about the basics of chemotherapy and preparing for treatment. The medications used to treat cancer are continually being evaluated. Talking with your doctor is often the best way to learn about the medications prescribed for you, their purpose, and their potential side effects or interactions with other medications. Learn more about your prescriptions by using searchable drug databases.

Getting care for symptoms and side effects

Cancer and its treatment often cause side effects. In addition to treatment to slow, stop, or eliminate the cancer, an important part of cancer care is relieving a person’s symptoms and side effects. This approach is called palliative or supportive care, and it includes supporting the patient with his or her physical, emotional, and social needs.

Palliative care is any treatment that focuses on reducing symptoms, improving quality of life, and supporting patients and their families. Any person, regardless of age or type and stage of cancer, may receive palliative care. It works best when palliative care is started as early as needed in the cancer treatment process.

People often receive treatment for the cancer and treatment to ease side effects at the same time. In fact, patients who receive both often have less severe symptoms, better quality of life, and report they are more satisfied with treatment.

Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional support, and other therapies. You may also receive palliative treatments similar to those meant to eliminate the cancer, such as chemotherapy, surgery, or radiation therapy. Talk with your doctor about the goals of each treatment in the treatment plan.

Before treatment begins, talk with your health care team about the possible side effects of your specific treatment plan and palliative care options. And, during and after treatment, be sure to tell your doctor or another health care team member if you are experiencing a problem so it can be addressed as quickly as possible.

Learn more about palliative care.

Metastatic eyelid cancer

If cancer has spread to another location in the body, it is called metastatic cancer. Rarely, melanoma, squamous cell carcinoma, or sebaceous carcinoma may spread to other parts of the body.

Patients with this diagnosis are encouraged to talk with doctors who are experienced in treating this stage of cancer, because there can be different opinions about the best treatment plan. Learn more about getting a second opinion before starting treatment, so you are comfortable with the treatment plan chosen. This discussion may include clinical trials.

Your health care team may recommend a treatment plan that includes a combination of surgery, radiation therapy, and chemotherapy. If the cancer has spread to nearby areas, such as the tumor invading the sinuses or brain, radical surgical resection (extensive surgery) may be an option.

However, surgery alone is not effective in treating eyelid cancer that has metastasized to distant parts of the body. To control the disease at this stage, chemotherapy, immunotherapy, targeted therapy, and/or radiation therapy may be necessary. Immunotherapy, also called biologic therapy, is designed to boost the body's natural defenses to fight the cancer. It uses materials made either by the body or in a laboratory to bolster, target, or restore immune system function. Learn more about immunotherapy. Palliative care will also be important to help relieve symptoms and side effects.

Your doctor may look for gene mutations in the tumor that can help direct the treatment, an approach called targeted therapy. For metastatic eyelid cancer, doctors often check for a BRAF mutation.

For most patients, a diagnosis of metastatic cancer is very stressful and, at times, difficult to bear. Patients and their families are encouraged to talk about the way they are feeling with doctors, nurses, social workers, or other members of the health care team. It may also be helpful to talk with other patients, including through a support group.

Remission and the chance of recurrence

A remission is when cancer cannot be detected in the body and there are no symptoms. This may also be called having “no evidence of disease” or NED.

A remission may be temporary or permanent. This uncertainty causes many people to worry that the cancer will come back. While many remissions are permanent, it’s important to talk with your doctor about the possibility of the cancer returning. Understanding your risk of recurrence and the treatment options may help you feel more prepared if the cancer does return. Learn more about coping with the fear of recurrence.

If the cancer does return after the original treatment, it is called recurrent cancer. It may come back in the same place (called a local recurrence), nearby (regional recurrence), or in another place (distant recurrence).

When this occurs, a cycle of testing will begin again to learn as much as possible about the recurrence. After testing is done, you and your doctor will talk about your treatment options. Often the treatment plan will include the treatments described above such as surgery, chemotherapy, and radiation therapy. However, they may be used in a different combination or given at a different pace. Your doctor may also suggest clinical trials that are studying new ways to treat this type of recurrent cancer.

Whichever treatment plan you choose, palliative care will be important for relieving symptoms and side effects.

People with recurrent cancer often experience emotions such as disbelief or fear. Patients are encouraged to talk with their health care team about these feelings and ask about support services to help them cope. Learn more about dealing with cancer recurrence.

If treatment fails

Recovery from cancer is not always possible. If the cancer cannot be cured or controlled, the disease may be called advanced or terminal.

This diagnosis is stressful, and advanced cancer is difficult to discuss for many people. However, it is important to have open and honest conversations with your doctor and health care team to express your feelings, preferences, and concerns. The health care team is there to help, and many team members have special skills, experience, and knowledge to support patients and their families. Making sure a person is physically comfortable and free from pain is extremely important.

Patients who have advanced cancer and who are expected to live less than six months may want to consider a type of palliative care called hospice care. Hospice care is designed to provide the best possible quality of life for people who are near the end of life.

You and your family are encouraged to think about where you would be most comfortable: at home, in the hospital, or in a hospice environment. Nursing care and special equipment can make staying at home a workable alternative for many families. Learn more about advanced cancer care planning.

After the death of a loved one, many people need support to help them cope with the loss. Learn more about grief and loss.

The next section in this guide is About Clinical Trials and it offers more information about research studies that are focused on finding better ways to care for people with cancer. Or, use the menu on the side of your screen to choose another section to continue reading this guide.

Eyelid Cancer - About Clinical Trials

Approved by the Lineagotica Editorial Board, 08/2015

ON THIS PAGE: You will learn more about clinical trials, which are the main way that new medical approaches are tested to see how well they work. To see other pages, use the menu on the side of your screen.

What are clinical trials?

Doctors and scientists are always looking for better ways to care for patients with eyelid cancer. To make scientific advances, doctors create research studies involving volunteers, called clinical trials. In fact, every drug that is now approved by the U.S. Food and Drug Administration (FDA) was previously tested in clinical trials.

Many clinical trials are focused on new treatments, evaluating whether a new treatment is safe, effective, and possibly better than the current (standard) treatment. These types of studies evaluate new drugs, different combinations of existing treatments, new approaches to radiation therapy or surgery, and new methods of treatment. Patients who participate in clinical trials are often among the first to receive new treatments before they are widely available. However, there is no guarantee that the new treatment will be safe, effective, or better than a standard treatment.  

There are also clinical trials that study new ways to ease symptoms and side effects during treatment and managing the late effects that may occur after treatment. Talk with your doctor about clinical trials regarding side effects. In addition, there are ongoing studies about ways to prevent the disease.

Deciding to join a clinical trial

Patients decide to participate in clinical trials for many reasons. For some patients, a clinical trial is the best treatment option available. Because standard treatments are not perfect, patients are often willing to face the added uncertainty of a clinical trial in the hope of a better result.

Other patients volunteer for clinical trials because they know that these studies are the only way to make progress in treating eyelid cancer. Even if they do not benefit directly from the clinical trial, their participation may benefit future patients with eyelid cancer.

Sometimes people have concerns that, in a clinical trial, they may receive no treatment by being given a placebo or a “sugar pill.” However, placebos are usually combined with standard treatment in most cancer clinical trials. When a placebo is used in a study, it is done with the full knowledge of the participants. Find out more about placebos in cancer clinical trials.

Patient safety and informed consent

To join a clinical trial, patients must participate in a process known as informed consent. During informed consent, the doctor should list all of the patient’s options so that the person understands how the new treatment differs from the standard treatment. The doctor must also list all of the risks of the new treatment, which may or may not be different from the risks of standard treatment. Finally, the doctor must explain what will be required of each patient in order to participate in the clinical trial, including the number of doctor visits, tests, and the schedule of treatment.

Patients who participate in a clinical trial may stop participating at any time for any personal or medical reason. This may include that the new treatment is not working or there are serious side effects. Clinical trials are also closely monitored by experts who watch for any problems with each study. It is important that patients participating in a clinical trial talk with their doctor and researchers about who will be providing their treatment and care during the clinical trial, after the clinical trial ends, and/or if the patient chooses to leave the clinical trial before it ends. 

Finding a clinical trial

Research through clinical trials is ongoing for all types of cancer. For specific topics being studied for eyelid cancer, learn more in the Latest Research section.

Lineagotica offers a lot of information about cancer clinical trials in other areas of the website, including a complete section on clinical trials and places to search for clinical trials for a specific type of cancer.

PRE-ACT, Preparatory Education About Clinical Trials

In addition, this website offers free access to a video-based educational program about cancer clinical trials, located outside of this guide.

The next section in this guide is Latest Research and it explains areas of scientific research currently going on for this type of cancer. Or, use the menu on the side of your screen to choose another section to continue reading this guide.    

Eyelid Cancer - Latest Research

Approved by the Lineagotica Editorial Board, 08/2015

ON THIS PAGE: You will read about the scientific research being done now to learn more about this type of cancer and how to treat it. To see other pages, use the menu on the side of your screen.

Doctors are working to learn more about eyelid cancer, ways to prevent it, how to best treat it, and how to provide the best care to people diagnosed with this disease. The following areas of research may include new options for patients through clinical trials. Always talk with your doctor about the diagnostic and treatment options best for you.

  • Advances in surgery. There have been significant improvements in surgical procedures to look for spread of a tumor from the periocular area (the area around the eye) to regional lymph nodes. Sentinel lymph node biopsy is one such technique in which the doctor removes one or a few lymph nodes near the tumor to check for cancer cells. You may want to talk with your doctor about the risks and benefits of this procedure.

  • Preventing and treating metastases. There have been numerous advances in the management of skin melanoma with a focus on drugs that may be helpful in preventing future spread. In addition, new combinations of chemotherapy for those with advanced or metastatic disease are also under investigation

  • Palliative care. Clinical trials are underway to find better ways of reducing symptoms and side effects of current eyelid cancer treatments in order to improve patients’ comfort and quality of life.

Looking for More About the Latest Research?

If you would like additional information about the latest areas of research regarding eyelid cancer, explore these related items that take you outside of this guide:

The next section in this guide is Coping with Side Effects and it offers some guidance in how to cope with the physical, emotional, and social changes that cancer and its treatment can bring. Or, use the menu on the side of your screen to choose another section to continue reading this guide.  

Eyelid Cancer - Coping with Side Effects

Approved by the Lineagotica Editorial Board, 08/2015

ON THIS PAGE: You will find out more about steps to take to help cope with physical, social, and emotional side effects. This page includes several links outside of this guide to other sections of this website. To see other pages, use the menu on the side of your screen.

Fear of treatment side effects is common after a diagnosis of cancer, but it may help to know that preventing and controlling side effects is a major focus of your health care team. This is called palliative care, and it is an important part of the overall treatment plan, regardless of the stage of disease.

There are possible side effects for every cancer treatment, but patients don’t experience the same side effects when given the same treatments for many reasons. That can make it hard to predict exactly how you will feel during treatment. 

Common side effects from each treatment option for eyelid cancer are described in detail within the Treatment Options section. Learn more about the most common side effects of cancer and different treatments, along with ways to prevent or control them. Side effects depend on a variety of factors, including the cancer’s stage, the length and dosage of treatment(s), and your overall health.

Talking with your health care team about side effects

Before treatment begins, talk with your doctor about possible side effects of each type of treatment you will be receiving. Ask which side effects are most likely to happen, when they are likely to occur, and what can be done to prevent or relieve them.

And, ask about the level of caregiving you may need during treatment and recovery, as family members and friends often play an important role in the care of a person with eyelid cancer. Learn more about caregiving.

In addition to physical side effects, there may be emotional and social effects as well. Patients and their families are encouraged to share their feelings with a member of their health care team who can help with coping strategies, including concerns about managing the cost of your cancer care

During and after treatment, be sure to tell the health care team about the side effects you experience, even if you feel they are not serious. Sometimes, side effects can last beyond the treatment period, called a long-term side effect. A side effect that occurs months or years after treatment is called a late effect. Treatment of both types of effects is an important part of survivorship care. Learn more by reading the Follow-up Care section of this guide or talking with your doctor.

The next section in this guide is Follow-up Care and it explains the importance of check-ups after cancer treatment is finished. Or, use the menu on the side of your screen to choose another section to continue reading this guide. 

Eyelid Cancer - Follow-Up Care

Approved by the Lineagotica Editorial Board, 08/2015

ON THIS PAGE: You will read about your medical care after cancer treatment is completed, and why this follow-up care is important. To see other pages, use the menu on the side of your screen.

Care for people diagnosed with cancer doesn’t end when active treatment has finished. Your health care team will continue to check to make sure the cancer has not returned, manage any side effects, and monitor your overall health. This is called follow-up care.

This plan may include regular physical examinations and/or medical tests to monitor your recovery for the coming months and years.

Most patients treated for eyelid cancer are successfully treated with a good cosmetic result. However, regardless, patients may need help coping with changes in appearance or in their self-image. Talk with your health care team about the support that is available to you.

Learn more about the importance of follow-up care.

Watching for recurrence

One goal of follow-up care is to check for a recurrence.  People treated for eyelid cancer need close observation by their ophthalmologist and oncologist to ensure that the tumor does not come back or spread to other organ systems.

Cancer recurs because small areas of cancer cells may remain undetected in the body. Over time, these cells may increase in number until they show up on test results or cause signs or symptoms. During follow-up care, a doctor familiar with your medical history can give you personalized information about your risk of recurrence.

Your doctor will also ask specific questions about your health. Some people may have blood tests or imaging tests as part of regular follow-up care, but testing recommendations depend on several factors including the type and stage of cancer originally diagnosed and the types of treatment given.

Managing long-term and late side effects

Most people expect to experience side effects when receiving treatment. However, it is often surprising to survivors that some side effects may linger beyond the treatment period. These are called long-term side effects. Most people do not have any long-term effects because of the cancer. In addition, other side effects called late effects may develop months or even years afterwards. Long-term and late effects can include both physical and emotional changes.

Talk with your doctor about your risk of developing such side effects based on the type of cancer, your individual treatment plan, and your overall health. If you had a treatment known to cause specific late effects, you may also have certain physical examinations, scans, or blood tests to help find and manage them.

Keeping personal health records

You and your doctor should work together to develop a personalized follow-up care plan. Be sure to ask about any concerns you have about your future physical or emotional health. ASCO offers forms to help create a treatment summary to keep track of the cancer treatment you received and develop a survivorship care plan once treatment is completed.

This is also a good time to decide who will lead your follow-up care. Some survivors continue to see their oncologist, while others transition back to the general care of their family doctor or another health care professional. This decision depends on several factors, including the type and stage of cancer, side effects, health insurance rules, and your personal preferences.

If a doctor who was not directly involved in your cancer care will lead your follow-up care, be sure to share your cancer treatment summary and survivorship care plan forms with him or her, as well as all future health care providers. Details about your cancer treatment are very valuable to the health care professionals who will care for you throughout your lifetime.

The next section in this guide is Survivorship and it describes how to cope with challenges in everyday life after a cancer diagnosis. Or, use the menu on the side of your screen to choose another section to continue reading this guide. 

Eyelid Cancer - Survivorship

Approved by the Lineagotica Editorial Board, 08/2015

ON THIS PAGE: You will read about how to cope with challenges in everyday life after a cancer diagnosis. To see other pages, use the menu on the side of your screen.

What is survivorship?

The word survivorship means different things to different people. Two common definitions include:

  • Having no signs of cancer after finishing treatment.

  • The process of living with, through, and beyond cancer. According to this definition, cancer survivorship begins at diagnosis and includes people who continue to have treatment over the long term, to either reduce the risk of recurrence or to manage chronic disease.

In some ways, survivorship is one of the most complex aspects of the cancer experience because it is different for every person.

Survivors may experience a mixture of strong feelings, including joy, concern, relief, guilt, and fear. Some people say they appreciate life more after a cancer diagnosis and have gained a greater acceptance of themselves. Others become very anxious about their health and uncertain of how to cope with everyday life.

Survivors may feel some stress when frequent visits to the health care team end following treatment. Often, relationships built with the cancer care team provide a sense of security during treatment, and people miss this source of support. This may be especially true as new worries and challenges surface over time, such as any late effects of treatment, emotional challenges including fear of recurrence, sexuality and fertility concerns, and financial and workplace issues.

Every survivor has individual concerns and challenges. With any challenge, a good first step is being able to recognize your fears and talk about them. Effective coping requires:

  • Understanding the challenge you are facing,

  • Thinking through solutions,

  • Asking for and allowing the support of others, and

  • Feeling comfortable with the course of action you choose.

Many survivors find it helpful to join an in-person support group or an online community of survivors. This allows you to talk with people who have had similar first-hand experiences. Other options for finding support include talking with a friend or member of your health care team, individual counseling, or asking for assistance at the learning resource center of the center where you received treatment.

Changing role of caregivers

Family members and friends may also go through periods of transition. A caregiver plays a very important role in supporting a person diagnosed with cancer, providing physical, emotional, and practical care on a daily or as-needed basis. Many caregivers become focused on providing this support, especially if the treatment period lasts for many months or longer.

However, as treatment is completed, the caregiver's role often changes. Eventually, the need for caregiving related to the cancer diagnosis will become much less or come to an end. Caregivers can learn more about adjusting to life after caregiving in this article.

A new perspective on your health

For many people, survivorship serves as a strong motivator to make positive lifestyle changes.

People recovering from eyelid cancer are encouraged to follow established guidelines for good health, such as not smoking, limiting alcohol, eating well, and managing stress. Regular physical activity can help rebuild your strength and energy level. Your health care team can help you create an appropriate exercise plan based upon your needs, physical abilities, and fitness level. Learn more about making healthy lifestyle choices.

In addition, it is important to have recommended medical check-ups and tests (see Follow-up Care) to take care of your health. Cancer rehabilitation may also be recommended, and this could mean any of a wide range of services such as physical therapy, career counseling, pain management, nutritional planning, and/or emotional counseling. The goal of rehabilitation is to help people regain control over many aspects of their lives and remain as independent and productive as possible. This is particularly important if treatment caused a loss of vision.

Talk with your doctor to develop a survivorship care plan that is best for your needs.

Looking for More Survivorship Resources?

For more information about cancer survivorship, explore these related items. Please note these links will take you to other sections of Lineagotica:

  • ASCO Answers Cancer Survivorship Guide: This 44-page booklet (available as a PDF) helps people transition into life after treatment. It includes blank treatment summary and survivorship care plan forms.

  • Lineagotica Patient Education Video: View a short video led by an ASCO expert that provides information about what comes next after finishing treatment.

  • Survivorship Resources: Lineagotica offers an entire area of this website with resources to help survivors, including for survivors in different age groups.

The next section offers Questions to Ask the Doctor to help start conversations with your cancer care team. Or, use the menu on the side of your screen to choose another section to continue reading this guide. 

Eyelid Cancer - Questions to Ask the Doctor

Approved by the Lineagotica Editorial Board, 08/2015

ON THIS PAGE: You will find some questions to ask your doctor or other members of your health care team, to help you better understand your diagnosis, treatment plan, and overall care. To see other pages, use the menu on the side of your screen.

Talking often with the doctor is important to make informed decisions about your health care. These suggested questions are a starting point to help you learn more about your cancer care and treatment. You are also encouraged to ask additional questions that are important to you.

You may want to print this list and bring it to your next appointment, or download Lineagotica’s free mobile app for an e-list and other interactive tools to manage your care.

Questions to ask after getting a diagnosis

  • What type of eyelid cancer do I have?

  • Can you explain my pathology report (laboratory test results) to me?

  • What stage and grade is the eyelid cancer? What does this mean?

  • Do I need treatment right away?

Questions to ask about choosing a treatment and managing side effects

  • What are my treatment options?

  • What clinical trials are open to me? Where are they located, and how do I find out more about them?

  • What treatment plan do you recommend? Why?

  • What is the goal of each treatment? Is it to eliminate the cancer, help me feel better, or both?

  • What are the possible side effects of this treatment, both in the short term and the long term?

  • Who will be part of my health care team, and what does each member do?

  • Who will be coordinating my overall treatment?

  • How will this treatment affect my daily life? Will I be able to work, exercise, and perform my usual activities?

  • Could this treatment affect my vision? For how long?

  • Could this treatment affect my sex life? If so, how and for how long?

  • Could this treatment affect my ability to become pregnant or have children? If so, should I talk with a fertility specialist before cancer treatment begins?

  • If I’m worried about managing the costs related to my cancer care, who can help me with these concerns?

  • What support services are available to me? To my family?

  • Whom should I call with questions or problems?

  • Is there anything else I should be asking?

Questions to ask about having surgery

  • What type of surgery will I have? Will lymph nodes be removed?

  • How long will the operation take?

  • How long will I be in the hospital?

  • Can you describe what my recovery from surgery will be like?

  • What are the possible long-term effects of having this surgery?

  • Will I need reconstructive or cosmetic surgery?

  • Will my appearance change?

Questions to ask about having radiation treatment

  • What type of radiation therapy is recommended?

  • What is the goal of this treatment?

  • How long will it take to give this treatment?

  • What side effects can I expect during treatment?

  • What are the possible long-term effects of having this treatment?

  • What can be done to relieve the side effects?

  • What does the preparation for this treatment involve?

  • What is the likelihood of my eye being damaged?

Questions to ask about having an eye removed

  • How do I adjust to having one eye?

  • How long will it take me to recover physically?

  • What rehabilitation services are available to me?

  • How soon can I get a prosthesis (artificial eye)?

  • When do I get a permanent prosthesis?

  • How do I care for my prosthesis?

Questions to ask about planning follow-up care

  • What is the risk of the cancer returning? Are there signs and symptoms I should watch for?

  • What long-term side effects or late effects are possible based on the cancer treatment I received?

  • What follow-up tests will I need, and how often will I need them?

  • How do I get a treatment summary and survivorship care plan to keep in my personal records?

  • Who will be coordinating my follow-up care?

  • What survivorship support services are available to me? To my family?

The next section in this guide is Additional Resources, and it offers some more resources on this website beyond this guide that may be helpful to you. Or, use the menu on the side of your screen to choose another section to continue reading this guide. 

Eyelid Cancer - Additional Resources

Approved by the Lineagotica Editorial Board, 08/2015

ON THIS PAGE: You will find some helpful links to other areas of Lineagotica that provide information about cancer care and treatment. This is the final page of Lineagotica’s Guide to Eyelid Cancer. To go back and review other pages, use the menu on the side of your screen.

Lineagotica includes many other sections about the medical and emotional aspects of cancer, both for the person diagnosed and their family members and friends. This website is meant to be a resource for you and your loved ones from the time of diagnosis, through treatment, and beyond.

Beyond this guide, here are a few links to help you explore other parts of Lineagotica:

This is the end of Lineagotica’s Guide to Eyelid Cancer. Use the menu on the side of your screen to select another section to continue reading this guide.