Eyelid tumors are a group of benign and malignant neoplasms, as well as tumors with local aggressive growth, but without the ability to distant metastasis. They are manifested by a cosmetic defect of varying severity. Plaques, nodules and ulcerative surfaces are found on the eyelid. Malignant and locally stimulating tumors of the eyelids can germinate nearby tissues. The diagnosis is made taking into account clinical signs, histological and cytological studies and the results of instrumental examinations. Treatment – surgery, cryodestruction, radiation therapy.
Eyelid tumors are benign, malignant and locally injecting neoplasms located in the upper or lower eyelid area. They make up about 80% of the total number of tumors of the eye and appendage. In most cases, they have a benign course. The most common malignant lesion is eyelid cancer, which accounts for slightly more than 30% of the total number of tumors in this area and slightly more than 5% of the total number of cases of skin cancer. Among the risk factors for the development of malignant tumors of the eyelids are chronic blepharitis, long–term ulcers, prolonged insolation, pigmented xeroderma and pigmented nevi. The probability of most neoplasms increases with age. The treatment is carried out by specialists in the field of oncology and ophthalmology.
Benign tumors of the eyelids
Characterized by slow progression, lack of infiltrating growth and the ability to distant metastasis. Usually they proceed favorably, the reason for going to the doctor is a cosmetic defect. More than 60% of the total number of eyelid tumors have epithelial origin (papilloma, senile wart), about 25% originate from soft tissues (lipoma, fibroma), 12% belong to the category of pigmented neoplasms (benign nevus).
Papilloma (papillary and flat acanthoepithelioma) of the eyelid is a node connected to the eyelid by a thin leg or a wide base. It can be single or multiple. It is usually located on the edge of the eyelid. In appearance, the papilloma of the eyelid may resemble a raspberry berry or a cauliflower inflorescence. A long-term asymptomatic course is characteristic. In some cases, it may become malignant. Sometimes the tumor of the eyelid, even in the absence of signs of malignancy, spreads beyond the skin to the lacrimal pathways, the mucous membrane of the eyelid and even the paranasal sinuses.
Senile wart (seborrheic keratosis, basal cell papilloma) is a tumor of the eyelids, similar in appearance to papillomatous nevus. It is an exophytically growing node of brown, grayish or yellowish color. It is usually located on the lower eyelid. Painless, dense to the touch. It can be greasy or dry. The tumor of the eyelid develops for many years, usually does not show a tendency to malignancy. There is more intense keratinization compared to papilloma.
Keratoacanthoma is a dense tumor of the eyelids with a diameter of 1-3 cm with a depression in the center. Along with the eyelids, it can affect the auricles, the cheeks and the back of the nose. Provoking factors are injuries, viral infections and prolonged contact with some toxic substances. It is prone to self-healing with the formation of a deforming retracted scar. The duration of the disease is 9-12 weeks. During the first 3-5 weeks, the eyelid tumor grows, then the stage of ulceration and healing begins. Usually does not recur.
Trichoepithelioma is a tumor of the eyelids arising from hair follicles. Usually develops in childhood or adolescence. It is a dense knot with a size of 1-3 mm. In some cases , it can grow up to 1 cm . It can be single or multiple, often more than 10 eyelid tumors are detected in one patient. It can become malignant, transforming into basal cell carcinoma. Treatment – cauterization or excision of nodules.
Syringoadenoma is a rare eyelid tumor originating from the epithelial lining of the sweat glands. It is a dense tumor-like formation consisting of many cavities. It is characterized by very slow growth.
Benign nevus is a group of pigmented tumors of the eyelids. It looks like a flat spot, nodule or papillomatous formation, usually located in the intramarginal space. The color of the eyelid tumor can be yellowish, light brown, rich brown or almost black. In childhood, there is a benign course. Adults have a tendency to malignant degeneration.
Fibroma is a tumor of the eyelids of mesodermal origin. It is a smooth knot on the base or a narrow leg. The diameter of the neoplasm can reach several centimeters. Very slow growth is characteristic. Malignancy is extremely rare. The treatment is operative.
Lipoma is another mesodermal tumor of the eyelids. It is usually detected in young women. As a rule, it is located in the upper eyelid area. Soft, elastic, yellowish when translucent. It can be one-sided or two-sided. Sometimes it is combined with lipomas of other localizations (in the chest, back, upper extremities). The treatment is operative.
Eyelid tumors with locally stimulating growth
Basal cell carcinoma is a fairly common tumor of the eyelids. It is the most common form of eyelid cancer, accounting for 75-80% of the total number of cases of the disease. Usually occurs after 50 years, less common in young patients. Basal cell tumors are usually localized in the outer corner of the eye, less often on the lower and upper eyelid or in the inner corner of the eye. Neoplasms of the lower eyelid are characterized by slower and less aggressive growth compared to lesions of the inner corner of the eye.
The basal cell is a nodule surrounded by a roller. The tumor of the eyelid slowly progresses, gradually sprouting surrounding tissues and destroying nearby anatomical formations. In advanced cases, it can destroy the eyeball, orbit and paranasal sinuses. It can give lymphogenic metastases, distant metastasis is detected extremely rarely. There are four forms of this eyelid tumor: nodular, superficial sclerotic, destructive and ulcerative.
The nodular form of the eyelid tumor is a painless light dense nodule on a wide base. With ulcerative form, a painless ulcer with raised edges appears in the eyelid area. Over time, the ulcer increases in size, bloody crusts form on its surface. The destructive form of the eyelid tumor is characterized by rapid aggressive growth. It becomes the cause of gross cosmetic defects, in a short time it grows into the surrounding tissues.
At the initial stage of the sclerotic form, scales appear in the eyelid area. A wet area appears under the scales, surrounded by a roller. Subsequently, a scarring focus is formed in the center of the affected area, along the edges of the eyelid tumor continues to grow. Treatment – surgical excision of basal cell carcinoma. When a defect occurs, reconstructive operations are performed. If the patient refuses surgery and small tumors of the eyelids located in the area of the inner corner of the eye, radiation therapy is used. The prognosis is favorable. Sustained long-term remission is observed in 95-97% of patients.
Progressive nevus is a pigmented tumor of the eyelids. It is congenital or develops at the age of 20 years. The growth of the neoplasm may be due to both malignancy and hormonal changes during puberty. Malignancy is indicated by a change in color, the appearance of a halo or uneven coloration, a hyperemia zone around the eyelid tumor, peeling, crusting and ulceration. Treatment – traditional surgical interventions, laser surgery, radiosurgery, possibly in combination with radiotherapy.
Malignant tumors of the eyelids
Eyelid cancer is a malignant neoplasm of the eyelid. It usually develops against the background of precancerous diseases of the eyelid skin. The group of oncological lesions of the eyelid with a tendency to distant metastasis includes squamous cell carcinoma and metatypical cancer. Squamous cell tumor of the eyelid in the initial stages is a small focus of mild erythema. Subsequently, a compaction zone appears in the affected area, turning into an ulcer with dense deepened edges. The tumor can produce both lymphogenic and hematogenic metastases. Metatypical cancer in its histological structure is an intermediate form between squamous and basal cell tumors of the eyelids. It is prone to rapid growth and early metastasis.
Treatment can be operative or conservative. Surgical removal or diathermoexcision of the neoplasm with surrounding unchanged tissues is performed. Close-focus radiotherapy is widely used. For small tumors of the eyelids, chemotherapy is sometimes used. In advanced cases, exenteration of the orbit is performed in combination with preoperative radiotherapy. The prognosis is quite favorable, the five-year survival rate is 88%.
Cancer of the meibomian glands is a rare tumor of the eyelids of a high degree of malignancy. It is usually located on the upper eyelid. It looks like a basal cell carcinoma. It progresses rapidly and metastasizes. The treatment is radiotherapy. Even with timely adequate treatment, 90% of patients have relapses within two years after the end of therapy. The five-year survival rate is 35-50%. The fatal outcome occurs as a result of metastasis.
Melanoma of the eyelid is the most malignant tumor of the eyelids. It is diagnosed infrequently. Usually melanoma is localized in the area of the lower eyelid, outer or inner corner of the eye. More often it is a flat spot with uneven vague contours, less often it is a node with a tendency to bleeding. Color – from yellowish to almost black. The eyelid tumor is surrounded by a zone of hyperemia and increased pigmentation. Flat neoplasms mainly grow on the surface, nodular forms quickly penetrate deep into the tissues.
With melanomas less than 10 mm in size, surgical excision is performed using microsurgical techniques. With tumors of the eyelids larger than 15 mm, radiation therapy is used. The prognosis depends on the thickness of the neoplasm. With melanomas less than 0.75 mm thick, the average five–year survival rate is about 100%, with nodes more than 1.5 mm thick – 50%. The cause of death is distant metastasis.