squamous cell carcinoma (SCC)

o SCC of the eyelid is uncommon, accounting for about 5% of all eyelid

tumours.
o It can occur from a precancerous condition, such as actinic keratosis or
Bowens disease.
o These tumours are also related to sun exposure and are similar to squamous
cell carcinoma of the skin.
o SCC tends to behave more aggressively and is more likely to spread than
BCC.
sebaceous gland carcinoma (SGC)
o SGC is cancer of the glands in the eyelid.
o It is a rare tumour that may account for up to 5% of all eyelid cancers.
o It occurs more often in women than men and occurs most often in the elderly.
o These tumours develop most often on the upper eyelid, followed by the lower
eyelid and the caruncle.
SGC can start in the Meibomian glands, glands of Zeis or the
sebaceous glands of the caruncle.
o SGC is often diagnosed at a later stage because it can mimic benign
conditions. It can also grow aggressively.
o SGC may be multifocal (occurring in more than one place), so they have a
tendency to recur after treatment.
malignant melanoma
o Melanoma of the eyelid is very uncommon and accounts for less than 1% of
all eyelid cancers.
o Melanoma of the eyelid is similar to melanoma of the skin of the skin. It is
staged and treated the same way as a skin melanoma.

Signs and symptoms

Eyelid tumours can sometimes imitate other eye disorders, such as inflammation of the
eyelid (blepharitis). Eyelid tumours can cause loss of eyelashes.
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Grades
The grade of eyelid carcinoma is based on the degree of differentiation of cells and their
rate of growth. The grading is the same as squamous cell carcinomas of the conjunctiva and
non-melanoma skin cancer.

Stages
Staging is a way of describing or classifying a cancer based on the extent of cancer in the
body. The most common staging system for carcinoma of the eyelid is the TNM system. The
International Union Against Cancer (UICC) uses the TNM system to describe the extent of
many solid tumour cancers.

The following information applies to eyelid carcinomas, including basal cell carcinoma,
squamous cell carcinoma and sebaceous gland carcinoma. Melanoma of the eyelid is staged
the same as melanoma skin cancer.

TNM
TNM stands for tumour, nodes, metastasis. TNM staging describes:

the size of the primary tumour

the number and location of any regional lymph nodes that have cancer cells in them
whether the cancer has spread or metastasized to another part of the body

Primary tumour (T)

TX

Primary tumour cannot be assessed.

T0

No evidence of primary tumour.

Tis

Carcinoma in situ.

T1

Tumour is 5 mm (0.2 inches) or less in size and has not spread into
the tarsal plateor the eyelid margin.

T2a

Tumour is more than 5 mm, but less than 10 mm (0.4 inches), in

size.
or
Any tumour that has spread into the tarsal plate or the eyelid
margin.

T2b

Tumour is more than 10 mm, but less than 20 mm (0.8 inches), in

size.
or
Tumour involves the full thickness of the eyelid.

T3a

Tumour is more than 20 mm in size.

or
The tumour has spread into nearby (adjacent) structures of the eye
or orbit.
or
The tumour has spread into the nerves (perineural invasion).

T3b

Extensive surgery (enucleation, exenteration or removal of the bone

[bone resection]) is required to completely remove the tumour.

T4

The tumour cannot be removed by surgery (not resectable) because

it has spread extensively into other structures, such as the eye,

orbit, craniosacral structures (including bones, nerves, fluids and
connective tissues of the cranium and spinal area) or the brain.

Regional lymph nodes (N)

NX

Regional lymph nodes cannot be assessed

N0

No regional lymph node metastasis

N1

Regional lymph node metastasis

Note: The regional lymph nodes include those around the ear (preauricular nodes), lower jaw
(submandibular nodes) and neck (cervical nodes).

Distant metastasis (M)

M0

No distant metastasis

M1

Distant metastasis

Stage grouping for eyelid tumours

The UICC further groups the TNM data into the stages listed in the table below.

UICC staging eyelid tumours

UICC
stage

TNM

Explanation

stage
0

Tis

N0

M0

Carcinoma in situ.

stage

T1

N0

M0

The tumour is 5 mm or less in size and has

IA

not spread into the tarsal plate or the margin

of the eyelid.
The cancer has not spread to any lymph
nodes or to other parts of the body.

stage
IB

T2a

N0

M0

The tumour is more than 5 mm but less than

10 mm in size.
or
The tumour has spread into the tarsal plate
or the eyelid margin.
The cancer has not spread to the lymph
nodes or to other parts of the body.

stage
IC

T2b

N0

M0

The tumour is more than 10 mm, but less

than 20 mm in size or involves the full
thickness of the eyelid.
The cancer has not spread to the lymph
nodes or to other parts of the body.

stage
II

T3a

N0

M0

The tumour is more than 20 mm in size.

or
The tumour has spread to nearby structures
of the eye or orbit.
or
The tumour has spread to the nerves
(perineural invasion).
The cancer has not spread to the lymph
nodes or to other parts of the body.

stage

T3b

N0

M0

IIIA

Enucleation, exenteration or removal of the

bone is required to completely remove the
tumour.
The cancer has not spread to the lymph
nodes or to other parts of the body.

stage

any

IIIB

stage
IIIC

T4

N1

M0

The cancer has spread to nearby lymph

nodes, but it has not spread to other parts of
the body.

any
N

M0

The tumour cannot be removed with surgery,

because it has spread extensively into other
structures, such as the eye, orbit,
craniosacral structures or the brain. The
cancer may or may not have spread to
nearby lymph nodes.
The cancer has not spread to other parts of
the body.

stage

any

any

IV

M1

The cancer has spread to other parts of the

body.

Recurrent eyelid carcinoma

Recurrent eyelid carcinoma means that the cancer has come back after it has been treated.
It may recur in the same location as the original cancer or it may recur in another part of
the body (metastatic eyelid carcinoma).
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Prognosis
Basal cell carcinoma (BCC) of the eyelid rarely spreads to lymph nodes or other organs, so
the prognosis for this type of tumour is usually very good.
Squamous cell carcinoma (SCC) can be more aggressive than BCC and can spread to the
orbit, lymph nodes or other organs. However, the prognosis is good if SCC of the eyelid is
detected early and can be completely removed.
The mortality rate (the number of people who die from the disease each year) for sebaceous
gland carcinoma of the eyelid is about 5%10%. However, sebaceous gland tumours are
often not diagnosed early and have a high rate of recurrence and spread (metastasis).
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Treatment
The treatment for tumours of the eyelid usually involves surgery.

Surgical excision (resection) is done to completely remove the tumour and a small
amount of healthy tissue from around the tumour.
Mohs surgery may also be used to treat eyelid tumours in certain situations.
o Mohs surgery is a special surgical method used to remove the eyelid tumour
layer by layer.
o The layers of tissue are examined under a microscope until the tissue is
completely free of cancer cells.
o Only specially trained surgeons perform this surgery, so it may not be
available at all treatment centres.
Curettage and electrodesiccation can also be used to treat some small, surface
(superficial) basal cell carcinomas of the eyelid.
o Curettage and electrodesiccation is a surgical procedure that uses heat or an
electric current to destroy cancerous tissue and control bleeding.
o The destroyed tissue is then scraped away.
If an eyelid tumour has spread into the orbit of the eye, orbital exenteration may be
necessary.

If surgery causes a defect of the eyelid, it can be repaired using reconstructive surgery.
Treatment options that may be used instead of surgery include:

Cryosurgery may be used for small, well-defined tumours.

External beam radiation therapy may be used:
o instead of surgery, if surgery would affect the persons appearance
o for recurrent or extensive eyelid tumours that are difficult to remove or
cannot be completely removed by surgery
o for people who are not well enough to have surgery or other treatments

Laser surgery is rarely used but may be an option for some small tumours.
Topical chemotherapy is rarely used but may be an option in certain cases.

For more information, go to treatment of basal cell carcinoma and treatment of squamous
cell carcinoma.

Treatment of squamous cell carcinoma

The following are treatment options for squamous cell carcinoma (SCC). The types of
treatments given are based on the unique needs of the person with cancer.
Treatment plans are designed to meet the unique needs of each person with cancer.
Treatment decisions for SCC are based on:

persons age
persons overall health
desired cosmetic result
number of lesions or tumours
size of the tumour
definition of tumour border
location of tumour
history of radiation therapy
whether the tumour is low or high risk

Surgery
Surgery is the primary treatment for SCC. The types of surgery that may be offered for SCC
include:

Mohs surgery
o This surgery is used to treat primary SCC, particularly tumours:
that occur at sites known to have high treatment failure rates
(periorbital area, nasolabial fold, nose-cheek angle, posterior cheek
sulcus, pinna, ear canal, forehead, scalp or tumours that start in a
scar)
with poorly defined borders
larger than 2 cm in diameter
in areas where the maximum preservation of tissue is desired
(tumours on the face, head or genitalia)
surgical excision
o It is used for most well-defined tumours less than 2 cm in diameter.
curettage and electrodesiccation
o This treatment is only used for very small SCC, not for larger tumours.
lymph node removal

Nearby lymph nodes may be removed if SCC is very large or deeply invasive,
or if lymph nodes feel enlarged or hard.

Radiation therapy
Radiation therapy may be the primary treatment for some SCC and is the main treatment
used as an alternative to surgery. External beam radiation therapy is used as the primarily
treatment for:

tumours requiring difficult or extensive surgery (such as those on the eyelids, nose
or ears)
elderly people who cannot tolerate surgery
recurrent tumours that are too large or deep to remove by surgery
relief of pain or to control symptoms of very large tumours (palliation)

Radiation therapy may be given after surgery (adjuvant therapy):

for tumours that cannot be removed completely (positive margins)

for tumours with nerve involvement
if there is a chance that some cancer remains

Chemotherapy
Topical chemotherapy may be used to treat in situ SCC (Bowens disease). The most
common topical chemotherapy drug is 5-fluorouracil (5-FU, Efudex).
It is rare for SCC to metastasize, so systemic chemotherapy is not commonly used to treat
it. Depending on the nature of the tumour, SCC may have the potential to spread to other
parts of the body. Systemic chemotherapy may be used to treat squamous cell carcinoma of
the skin that has spread to lymph nodes or distant organs. Although chemotherapy will not
cure the cancer, it may slow the growth of the cancer and relieve symptoms.
The most common systemic chemotherapy drugs used to treat SCC that has spread to other
parts of the body include:

cisplatin (Platinol AQ)

doxorubicin (Adriamycin)
5-fluorouracil (5-FU, Adrucil)
mitomycin (Mutamycin)

Clinical trials
People with SCC may be offered the opportunity to participate in clinical trials. For more
information, go to clinical trials.

American Cancer Society. (2010, 7/20). Skin Cancer - Basal and Squamous Cell. Atlanta:
American Cancer Society.

National Cancer Institute. (2011, 2/18). Skin Cancer Treatment (PDQ) - Patient Version.
Bethesda, MD: National Cancer Institute.

National Cancer Institute. (2010, 10/28). Skin Cancer Treatment (PDQ) - Health
Professional Version. Bethesda, MD: National Cancer Institute.