Basal cell carcinoma is the most common eyelid tumour in Caucasians in the UK. It affects thousands each year. These tumours can be benign or malignant, and knowing about them is key for eye health.
Eye and eyelid tumours include many types, from common to rare. Some are harmless, but others can spread. This article will help you understand these growths and how to deal with them.
Key Takeaways
- Basal cell carcinoma is the most common malignant eyelid tumour in Caucasians, while sebaceous gland carcinoma is the most common in Asians.
- Approximately 85% of all eyelid tumours are benign, including epithelial lesions, basal cell carcinoma, cystic lesions, and melanocytic lesions.
- Actinic keratosis is the most common precancerous cutaneous lesion that may transform into squamous cell carcinoma (SCC).
- Uveal melanoma is one of the most common forms of eye cancer, affecting adults aged 60 years and older.
- Retinoblastoma is the most common childhood eye cancer, affecting around 200 children in the United States each year.
Anatomy of the Eyelids
The eyelids are vital for protecting our eyes and keeping the tear film in place. They are made up of many layers, each with its own role. These layers can develop different eyelid tumours.
Structure and Layers
The eyelids have four main parts: skin, muscle, tarsus, and conjunctiva. This setup helps them shield the eye, make tears, and keep the tear film intact.
Glandular Tissue and Melanocytes
The eyelids have special glands and cells. There are sweat glands, Moll’s glands, and meibomian glands. Melanocytes in the eyelid’s skin add colour. These elements can lead to various tumours, both benign and malignant.
| Eyelid Structure | Function |
|---|---|
| Skin and Subcutaneous Tissue | Provides protection and allows eyelid movement |
| Orbicularis Oculi Muscle | Responsible for closing the eyelids |
| Tarsal Plates | Provide structure and support for the eyelids |
| Meibomian Glands | Secrete an oily substance to prevent eyelids from sticking together |
| Palpebral Conjunctiva | Lines the inner surface of the eyelids |
Classification of Eyelid Tumours
Eyelid tumours are divided into types based on where they start and if they are cancerous. Most grow from the outer layers of the skin, leading to epithelial or melanocytic tumours. But, other types like adnexal, stromal, lymphoid, and metastatic tumours can also appear.
Tumour Types and Origins
Knowing where an eyelid tumour comes from is key to choosing the right treatment. These tumours make up 5–10% of all skin cancers. Most are benign, making up 82–98% of all growths.
- Basal cell carcinoma (BCC) is the most common malignant eyelid tumour among Caucasians, with an incidence of 86–91%.
- Sebaceous gland carcinoma (SGC) accounts for 32% of eyelid tumours in regions like China and India, and it comprises the majority (67–77%) of malignant eyelid tumours in Asian countries.
- Merkel cell carcinomas (MCC) of the eyelid are rare, constituting 5–20% of head and neck tumours, predominantly in Caucasians.
Tumours of the eyelids can be benign, pre-malignant, or malignant. Patients might need to see doctors for up to three years to check for recurrence. Some cancers, like basal cell carcinoma and squamous cell carcinoma, can be treated with Mohs micrographic surgery.
| Tumour Type | Prevalence | Dominant Ethnicities |
|---|---|---|
| Basal Cell Carcinoma (BCC) | 86-91% of malignant eyelid tumours | Caucasians |
| Sebaceous Gland Carcinoma (SGC) | 32% of eyelid tumours 67-77% of malignant eyelid tumours |
Asian countries |
| Merkel Cell Carcinoma (MCC) | 5-20% of head and neck tumours | Caucasians |
“Eyelid tumours are generally managed with complete removal and reconstructive surgery.”
Benign Epithelial Tumours
There are several types of benign epithelial tumours on the eyelids. These growths are not cancerous but can still affect how the eyelids look and work. Squamous papilloma and seborrheic keratosis are two common ones.
Squamous Papilloma
Squamous papilloma is the most common benign epithelial tumour of the eyelid. It looks like a small growth on the eyelid and is more common in older adults. It has a keratinised surface and is made of benign squamous epithelium.
Seborrheic Keratosis
Seborrheic keratosis is another common eyelid skin lesion, mainly affecting older people. It appears as well-defined, warty plaques that can change in size and colour. It is made of acanthotic basaloid cells with hyperkeratosis and keratin-filled cystic inclusions.
“Benign epithelial neoplasms are six to eight times more common than malignant eyelid lesions.”
Even though these Benign Eyelid Tumours are not dangerous, they can still worry people. Getting a proper diagnosis and treatment is key to managing these Eyelid Lesions well.
Premalignant and Malignant Epithelial Tumours
Eyelid tumours come in many types, some of which can be dangerous. Actinic Keratosis, or solar keratosis, is a common early warning sign. It’s caused by UV damage and shows up as red, scaly, and sometimes lumpy spots.
Actinic Keratosis is a sign of Squamous Cell Carcinoma and can turn into a serious cancer if not treated. Research shows that about 59% of eyelid growths are from the top layer of skin. Around 1.5% are cancerous, and 6% are like Actinic Keratosis or Bowen’s disease.
Another study found that 85.7% of eyelid tumours are harmless, 1.1% are early signs of cancer, and 13.1% are cancerous. Most cancers are Basal Cell Carcinomas, but Squamous Cell Carcinomas and Sebaceous Carcinomas are also common. In the US, it’s estimated that 40 million people have Actinic Keratosis.
It’s important to watch for and treat these tumours early to stop them from getting worse. People with certain tumours might need to see an oncologist. Those with eyelid tumours often need to see doctors regularly for up to five years after treatment.
Melanocytic Lesions and Melanoma
Eyelid melanocytic lesions, like nevi and melanomas, are serious health issues. Ocular melanoma, especially uveal or choroidal, is a common eye cancer in adults. These tumours can start in the iris, ciliary body, or choroid. They can spread to other parts of the body. It’s vital to catch these early and treat them right to avoid bad outcomes.
Eyelid melanomas are rare, making up less than 1% of all skin cancers. They are hard to spot and treat. These tumours often show up in people aged 50-80, 20 years after skin cancers elsewhere. Lower eyelid melanomas happen about 2.6 times more than upper eyelid ones.
Diagnosing eyelid melanoma needs careful steps, like biopsies and tests. Tests like S100, MelanA/MART-1, and HMB-45 help find melanocytic cells. They help tell if a lesion is benign or malignant.
Treatment for eyelid melanoma usually means surgery. This can be simple eyelid removal, Mohs surgery, or even removing the eyelid. Sometimes, radiation therapy is used if surgery can’t get all the cancer. Patients also get PET/CT scans to check for cancer spread.
Hutchinson’s Freckle, or primary acquired melanosis (PAM), is a risky lesion. It can turn cancerous and needs aggressive treatment. A team of ophthalmologists, dermatologists, and oncologists is key to managing these lesions and melanoma well.
| Statistic | Value |
|---|---|
| Percentage of all cutaneous malignant melanomas accounted for by primary melanomas of the eyelid skin | |
| Percentage of head and neck melanomas that are primary melanomas of the eyelid skin | |
| Ratio of lower eyelid melanomas to upper eyelid melanomas | 2.6:1 |
| Sensitivity of S100 stain for melanocytes | 97-100% |
| Specificity of S100 stain for melanocytes | 75-87% |
| Sensitivity of MelanA/MART-1 stain | 75-92% |
| Specificity of MelanA/MART-1 stain | 95-100% |
| Sensitivity of HMB-45 stain | 69-93% |
| Specificity of HMB-45 stain | Nearly 97% |
| Recurrence rates for Mohs micrographic surgery for melanoma in-situ | 0-3.6% |
| Recurrence rates for surgical excision of melanoma in-situ | 6-20% |
“All pigmented eyelid tumours should be evaluated by an eye cancer specialist.”
Eye and Eyelid Tumours
Benign and Malignant Tumours
The eye can have both benign and malignant growths. Benign tumours like choroidal nevi and hemangiomas might not harm vision but can still affect it. On the other hand, malignant intraocular tumours, such as uveal melanoma, can spread and threaten health.
Uveal or Choroidal Melanoma
Uveal melanoma, also known as choroidal melanoma, is a common eye cancer in adults. It starts in the melanocytes of the uveal tract, which includes the iris, ciliary body, and choroid. This cancer can cause vision loss and spread, especially to the liver, if not treated early.
“Basal cell carcinoma is the most common malignant eyelid tumor, with a prevalence in fair-skinned individuals between the ages of 50 and 80.”
Treatment for Benign Eye Tumours and Malignant Eye Tumours includes surgery, cryotherapy, radiation, and targeted therapies. Finding Ocular Tumours, especially Uveal Melanoma and Choroidal Melanoma, early is key for better treatment and outcomes.
Lymphoma of the Eye
Lymphoma, a blood cancer, can affect the eye in different ways. There are primary intraocular lymphoma and ocular adnexal lymphoma. Each needs special care and treatment.
Primary Intraocular Lymphoma
Primary intraocular lymphoma, or primary vitreoretinal lymphoma (PVRL), is a rare and aggressive cancer. It starts in the eye. Most people with PVRL have it in both eyes.
Also, most have lymphoma in their brain, called primary central nervous system lymphoma.
Ocular Adnexal Lymphoma
Ocular adnexal lymphoma starts in the eye’s surrounding tissues. It’s very rare. It’s treated with radiotherapy and chemotherapy, like other body lymphomas.
It mainly affects older people or those with weak immune systems. Symptoms include blurry vision, lost vision, and eye pain.
Diagnosis involves an eye exam, imaging, and a biopsy. Treatment combines chemotherapy and radiation. Sometimes, chemotherapy is given directly into the eye or veins.
Childhood Eye Cancers
Childhood eye cancers are rare but can deeply affect young lives. The most common types are Retinoblastoma and Medulloepithelioma.
Retinoblastoma
Retinoblastoma is the most common eye cancer in kids, hitting those under 5. It starts in the retina and can affect one or both eyes. Early treatment leads to a high survival rate, over 90%.
Medulloepithelioma
Medulloepithelioma is very rare and strikes young kids, usually under 10. It grows in the ciliary body and grows slowly. Symptoms include vision changes, bulging eyes, and eye pain. Surgery to remove the eye is often the treatment.
Though rare, childhood eye cancers need quick action and special care. Early diagnosis and the right treatment are key. They help improve life quality for kids and their families.
“With early detection and appropriate treatment, the prognosis for children with retinoblastoma is generally good, with a survival rate of over 90%.”
| Type of Childhood Eye Cancer | Incidence | Prognosis |
|---|---|---|
| Retinoblastoma | Most common childhood eye cancer | Survival rate over 90% with early detection and treatment |
| Medulloepithelioma | Extremely rare | Typically slow-growing, treatment often involves eye removal |
Squamous Cell Cancer and Conjunctival Neoplasia
Squamous cell carcinoma is the most common cancer of the conjunctiva. This is the clear membrane at the front of the eye. It grows on the surface but can spread to other tissues. Conjunctival intraepithelial neoplasia (CIN) is a precancerous condition that can turn into invasive squamous cell carcinoma if not treated.
The occurrence of these eye lesions differs by region and population. A 2005 study in Japan looked at the prevalence of eyelid and conjunctival tumours. A 1999 study in Minnesota examined the characteristics and course of malignant eyelid tumours.
Treatment for these lesions includes surgery, cryotherapy, and topical chemotherapy. Research has identified risk factors like smoking, UVB rays, HPV, and immunodeficiency viruses.
| Location | Incidence of Ocular Surface Squamous Neoplasia (OSSN) |
|---|---|
| Uganda | 0.13 per lakh |
| United Kingdom | Less than 0.2 cases per million per year |
| Brisbane, Australia | 1.9 per 100,000 population |
The incidence of Ocular Surface Squamous Neoplasia (OSSN) varies widely. In the UK, it’s less than 0.2 cases per million yearly. But in Uganda, it’s 0.13 per lakh. In Brisbane, Australia, it’s 1.9 per 100,000.
Geographic location, sun exposure, and demographic factors affect the prevalence of Squamous Cell Carcinoma and Conjunctival Neoplasia. Ongoing research aims to understand these conditions better.
Conclusion
Eye and eyelid tumours come in many types, both harmless and dangerous. They start from different cells and tissues in the eye and around it. Knowing about these tumours is key for catching them early and treating them right.
New ways to diagnose and treat eye tumours have made a big difference. It’s vital to get regular eye checks and see a doctor quickly if something looks off. This helps catch problems early and keeps eyes healthy.
With more knowledge and better treatments, doctors can help patients more than ever. Keeping up with the latest in eye tumour care means better lives for those with these conditions. It’s all about giving patients the best care possible.
FAQ
What are eye and eyelid tumours?
Eye and eyelid tumours are growths that can appear in or around the eye. They can be either benign (non-cancerous) or malignant (cancerous).
What are the common types of eye and eyelid tumours?
Common types include basal cell carcinoma, sebaceous gland carcinoma, and melanoma. Lymphoma and rare childhood cancers like retinoblastoma and medulloepithelioma are also common.
How are the eyelids structured?
The eyelids have four main layers. These are skin and subcutaneous tissue, striated muscle, tarsus with meibomian glands, and the palpebral conjunctiva.
What types of glandular tissue are present in the eyelids?
The eyelids have a lot of glandular tissue. This includes eccrine sweat glands, apocrine glands of Moll, and sebaceous meibomian glands. Melanocytes are also present in the basal layer of the eyelid epithelium.
How are eyelid tumours classified?
Eyelid tumours are classified by their tissue or cell of origin and whether they are benign or malignant. Most are of cutaneous origin, primarily from the epidermal layers.
What are some examples of benign epithelial eyelid tumours?
Squamous papilloma and seborrheic keratosis are common benign epithelial eyelid tumours.
What is actinic keratosis and how is it related to eyelid tumours?
Actinic keratosis is a common premalignant cutaneous lesion on the eyelids. It’s caused by ultraviolet radiation damage. If left untreated, it can turn into invasive squamous cell carcinoma.
What are the types of melanocytic lesions that can develop in the eyelids?
Melanocytic lesions, like nevi and melanomas, can occur in the eyelids. Ocular melanoma, especially uveal or choroidal melanoma, is a common primary eye cancer in adults.
What are the types of eye tumours that are not specific to the eyelids?
The eye itself can have growths, like choroidal nevi, hemangiomas, and uveal melanoma. These are not specific to the eyelids.
What is uveal melanoma, and why is it important?
Uveal melanoma, or choroidal melanoma, is a common primary eye cancer in adults. It starts from melanocytes in the uveal tract. It can cause vision loss and spread if not treated quickly.
What are the different types of ocular lymphoma?
Ocular lymphoma can be in the eyeball (primary intraocular lymphoma) or around the eye (ocular adnexal lymphoma). It’s treated with radiotherapy and chemotherapy.
What is retinoblastoma, and what is the prognosis for children with this condition?
Retinoblastoma is the most common childhood eye cancer, affecting kids under 5. Early detection and treatment give a good prognosis, with over 90% survival rate.
What is medulloepithelioma, and how is it treated?
Medulloepithelioma is a rare eye cancer in young children, usually under 10. It’s treated by removing the affected eye through surgery.
What is squamous cell carcinoma of the conjunctiva, and how is it managed?
Squamous cell carcinoma is the most common cancer of the conjunctiva. Treatment options include surgery, cryotherapy, and topical chemotherapy.
