Keywords

Overview and Epidemiology

Eyelid is a common place for skin cancer to occur and constitute 5–10% of all skin cancers. Eyelid neoplasms comprise a variety of benign and malignant growths (Table 1.1). Significant majority of these growths are benign in nature and constitute 82–98% of all neoplasms (Table 1.2). There is wide, racial, and probable geographical variation reported in the incidence of the various eyelid tumors. Eyelid malignancies vary in distribution and presentation. The most common malignant eyelid tumor in western literature is basal cell carcinoma (BCC) comprising 86–91% incidence among the Caucasians [7, 12]. However, in one of the largest series from China and India this incidence is much lower, consequently sebaceous gland carcinoma (SGC) constitutes 32% of all eyelid tumors [6, 13]. In studies from Asian countries [2, 14, 15] it is the sebaceous gland carcinoma which constitutes the majority (67–77%). The mean age for benign tumor is lower than that of malignant tumors. Epithelial tumor and dermoid cysts are the most common eyelid tumor in children [16]. Malignant eyelid tumor in children is extremely rare. When it presents, is usually a part of a systemic process, genetic defects or following radiation treatment [17, 18]. Merkel cell carcinomas (MCC) of the eyelid are rare neuroendocrine tumor constituting 5–20% of the head and neck tumor, predominantly in Caucasians [19].

Table 1.1 Regional incidence of benign and malignant eyelid neoplasms in the epidemiological studies
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Table 1.2 Eyelid tumors originating from epidermis
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Classification of Eyelid Tumors

Eyelid tumors can arise from various histological layers eyelid is composed of. Eyelid tumors are classified as benign or malignant or according to the tissue or cell of origin (Tables 1.2, 1.3 and 1.4). They can be subdivided into non-melanocytic and melanocytic tumors. Benign epithelial proliferations such as squamous papilloma, pseudoepitheliomatous hyperplasia, seborrheic keratosis, keratoacanthoma cysts and nevi are common. Among the malignant, BCC (Figs. 1.1 and 1.2) is the most common in Caucasians and SGC among the Asians (Fig. 1.3), followed by squamous cell carcinoma (SCC) and malignant melanoma (MM) (Figs. 1.4, 1.5, 1.6, 1.7 and 1.8). The large majority of BCC (93%) was seen in 71% of females [2] SGC has predilection for the upper lid [20]. Merkel cell cancer has higher prevalence in men. Primary malignant melanomas of the eyelid skin are rare and account for 0.2–13% of all reported cases [2, 7]. They occur 20 years later than other non-melanoma tumor and have 2.6 times predilection for the lower lid. Eyelids can also be involved by secondary and metastatic lesions.

Table 1.3 Fibrous, fibrohistiocystic, and muscular eyelid tumors
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Table 1.4 Eyelid tumors arising from vascular, perivascular, neural, lipomatous, cartilage, bone lymphoid tumors, hamartomas, and choristomas
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Fig. 1.1
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(a) Basal cell carcinoma involving the lower lid. (b) Ulcerative basal cell carcinoma involving the medial canthus. (c) Basal cell carcinoma involving the upper lid with central necrotic area. (d) Morpheaform type of basal cell carcinoma involving the lower lid

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Fig. 1.2
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Extensive basal cell carcinoma involving both medial canthi, nose and cheek

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Fig. 1.3
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Sebaceous gland carcinoma misdiagnosed as chalazion and surgically intervened

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Fig. 1.4
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Malignant melanoma involving lower lid and conjunctiva

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Fig. 1.5
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Extensive malignant melanoma involving both the eyelids in a patient with xeroderma pigmentosa

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Fig. 1.6
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Rapidly growing squamous cell carcinoma of the eyelid and extending to the orbit

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Fig. 1.7
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(a) Kissing nevus in a young adolescent girl. (b) Nevi involving the upper lid in a young adult with a history of recent growth. (c) Nevus involving the lid margin in a young adult. (d) Keratoacanthoma

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Fig. 1.8
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(a) Squamous papilloma of the lower eyelid. (b) Lymphangioma diffusely involving the lids and orbit. (c) Extensive Xanthelesma involving all four lids

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All primary carcinomas of the eyelid can be classified based on their clinical and histological presentation using the TNM [tumor, nodes (lymph), metastasis] by AJCC (8th Ed) classification system [21]. TNM staging describes the size of tumor, number and location of regional lymph nodes which have malignant cells in them and whether the malignant cells have spread or metastasized to another part of the body. The TNM classification of eyelid carcinomas reflects both morbidity and mortality risks in order to provide useful guidelines for patient management.