The word “tumor” can be a frightening word for people to hear – many patients view “tumour” as being synonymous with “malignant cancer”. It’s important not to confuse the two terms.
The first distinction to be made is the difference between an inflammatory swelling in the eyelid area and “more tissue”. Eyelid tissue is delicate and a slight inflammation can lead to a massive swelling, and there can be many causes of this inflammation, including an inflamed lacrimal gland or an infection caused by a small injury.
If there is a real “extra tissue” (such as from a tumor), then it is often benign changes such as an encapsulated barley grain, a wart, or a so-called “molluscum contagiosum”, caused by a harmless, but contagious virus.
However, various malignant tumors (carcinomas) do occur on the eyelids. The most common malignant eyelid tumor is basal cell carcinoma (90%), followed by squamous cell carcinoma (~5%) and sebaceous carcinomas (~5%). In all cases, suspected malignant tumors should be treated quickly. If necessary, we will consult specialists of other disciplines such as internists, dermatologists or oncologists (cancer specialists).
Basal cell carcinoma (BCC): 90% of all malignant eyelid tumours. BCCs are the result of intensive, long-term sun exposure of the skin, preferably in fair-skinned people. BCCs grow locally and only rarely form new tumours (metastases) in other parts of the body.
Squamous cell carcinomas (SCC): make up about 5% of malignant lid tumours. Here, too, excessive sunlight plays a role. The lower eyelid, like in BCC, is more frequently affected because it receives more sunlight. Squamous cell carcinoma metastasizes in about 20% of cases, initially to the lymph nodes of the ear and jaw.
Sebaceous Carcinomas: Make up about 5% of malignant eyelid tumours. Arises on degeneration of a sebaceous gland. This tumour is aggressive and metastasizes early.
For small tumors, we first take a biopsy in a short outpatient procedure. The material is sent to a laboratory and examined under the microscope to confirm the diagnosis. In a second operation, the tumor is removed.
For large tumors, the tumor is excised, plus an additional region of what appears to be non-tumour tissue to ensure all of the tumor has been removed, and this often requires the patient to be under general anaesthesia. This is followed by what’s called “rapid-cut diagnosis” – the pathologist examines the material immediately under the microscope and informs us 1–2 hours after removal whether the cut edges are free of tumour. Subsequently, the reconstruction of the lid takes place on the same day in a second operation.
The next step is lid reconstruction. There are a variety of surgical options available to do this, and in general, eyelid reconstruction has made tremendous progress over the past two decades.
In the past, large skin transplants from the middle of the face were used to replace one or even both eyelids – and sometimes eyes were removed altogether. Fortunately, thanks to improved techniques, this “radical” surgery is no longer used in most cases today.
These days, defects of all sizes, including the complete lid can be covered by material derived from near the eyelids. Which method is used depends on how much of the eyelid needed to be removed (or in other words, how big the defect needing to be covered is). Modern surgical techniques range from a direct closure, to skin grafts, muscle or connective tissue slices, which are taken from the upper / lower lid of the same side or the lids of the other, healthy eye.
In rare cases where more skin is necessary, this is taken from behind the ear.
In addition, some of the modern procedures require two rounds of surgery, where the lid is reconstructed and the eye can not be opened for about 10 days. This is followed by another (short) intervention to complete the reconstruction.
The number one priority in this surgery is that the carcinoma is completely removed. Of course, attention is paid to cosmetic appearance, but the former is vital, the latter is not. For large tumours, it may be expected that the eyelid will not look exactly as it did before surgery even after successful surgery.
If a skin graft is needed, it’s worth noting that the graft may have a different shade than the surrounding skin.
Even after complete removal of the carcinoma, there is still the danger that it may recur years after the operation. Please be aware that in the first 3 years after the operation, we will need 6-month check-ups. Later, the time between check-ups can be increased.