Eyelid Conditions-Tumors And Treatment

What is a tumor? 
A tumor is an irregular growth of tissue, and can be benign (implying limited growth), pre-malignant (with the potential to become malignant) or malignant (implying an ability to grow and spread to other parts of the body – ‘metastasise’).

What are the causes of tumors?
In most cases the exact cause of a tumor is not known, but factors which are thought to play a role are:

( i ) The environment. A striking example is exposure to sunlight which increases the risk of eyelid skin tumors, particularly in fair-skinned individuals.

( ii ) The immune system (which also protects against infections). For this reason, patients on strong drugs which suppress the immune system are at greater risk of developing tumors.

( iii ) Inheritance. Most have a genetic predisposition, although tumors inherited directly from a parent are exceptionally rare.

What are the symptoms?
The symptoms vary according to the location and nature of the tumor. Tumors of the eyelids may cause local swelling, a localized loss of the eyelashes (madarosis), redness or irritated eyes.
The most common tumors of the eyelids include basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). BCCs, SCCs, and melanomas account for 90 %, 5%, and 3% of malignant periocular tumors.

To be sure of the diagnosis, a biopsy may be necessary, although in many typical BCCs cases, the treatment can be done simultaneously with the biopsy. However, when a tumor is near the eyelids, considering the complex anatomical nature of the eyelids, a biopsy is often preferred before starting any treatment.

Can tumors pose a risk to the eye and vision? 
Yes – either as a result of infiltration and deformation of the eyelid with reduced corneal protection (BCC, SCC), or direct involvement of the corneal surface (SGC), or due to spreading into the orbit (any tumor). Moreover, if left untreated for a long time, complete excision can result in a larger tissue deficit (and even loss of the eye in rare cases), thus necessitating more extensive reconstructive surgery with a greater risk to the overall protection of the eye.

What is their treatment? 
Eyelid tumors are generally treated with a complete excision and reconstructive oculoplastic surgery. Reconstructive surgery is usually performed simultaneously with the removal of the tumor or more rarely within a few days, if the tumor is required to be sent for a biopsy to confirm that it has been completely removed before oculoplastic rehabilitation. Some tumors may be treated with local freezing (cryotherapy), irradiation, or medical treatments which stimulate the immune system to destroy abnormal tumor cells.

What is the follow up period after surgery to treat a tumor? 
Because of the risk of recurrence of an eyelid tumor, patients are usually re examined at regular intervals 3 to 10 years after treatment depending on the type of tumor.