This document discusses the main types of malignant eyelid tumors: basal cell carcinoma, squamous cell carcinoma, sebaceous gland carcinoma, and melanoma. Basal cell carcinoma is the most common eyelid malignancy, usually appearing as a nodular or ulcerative lesion on the lower eyelid. Squamous cell carcinoma is more aggressive but less common. Sebaceous gland carcinoma often resembles a chalazion and occurs more frequently on the upper eyelid. Melanoma can arise from pre-existing nevi and presents as lentigo maligna, superficial spreading, or nodular subtypes. Surgical excision is the main treatment approach for these eyelid cancers.

1. Malignant Tumor of the Eyelid
Basal Cell Carcinoma
Squamous Cell Carcinoma
Sebaceous Gland Carcinoma
Melanoma
dr. Frenky R. de Jesus
National Eye Centre
Postgraduate diploma in Ophthalmology

2. Malignant Tumor of the Eyelid
dr. Frenky - 19/07/18
Normal Layers of the Skin

3. Malignant Tumor of the Eyelid
dr. Frenky - 19/07/18
Types

4. Malignant Tumor of the Eyelid
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Basal Cell Carcinoma

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Basal Cell Carcinoma
• Basal Cell carcinoma: is the most common human malignancy and most
frequently affects elderly patients.
• Risk factors are
• Fair skin,
• Inability to tan,
• Chronic exposure to sunlight,
• Male >50 y/o,
• History of cigarettes smoking,
• Prior basal cell carcinoma,
• Family history of skin cancer.
• 90%: head and neck and 10%: involve the eyelid.
• BCC is by far the most common malignant eyelid tumor, accounting 90% of
all cases.
• The tumor is slow growing and locally invasive but non metastisizing.

6. Malignant Tumor of the Eyelid
dr. Frenky - 19/07/18
• It most frequently arises from the lower eyelid, followed in relative frequency
by medial canthus, upper eyelid and lateral canthus.
• Tumor located at medial canthus are more prone to invade the orbit and
sinuses, are more difficult to manage than those arising elsewhere and carry
the greatest risk of recurrence.

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Clinical Types
• The main clinical features of epidermal cell malignancy are ulceration, lack of
tenderness, induration, irregular borders and destruction of lid margin architecture.
Nodular BCC
Is a shiny, firm, pearly
nodule with small dilated
blood vessels on its
surface.
Initially, growth is slow
and it may take the tumor
1-2 years to reach a
diameter of 0.5 c.

8. Malignant Tumor of the Eyelid
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Clinical Types
Sclerosing BCC (Morphoeic) is less common and may be
difficult to diagnoses because its infiltrate laterally beneath
the epidermis as an ideated plaque.
The margins of the tumor may be impossible to delineate
clinically and the lesion tend to be much more extensive on
palpation than inspection.
On cursory examination a sclerosing BCC may simulated a
localized area of chronic blepharitis.
Noduloulcerative BCC
(rodent ulcer)
Has central ulceration, pearly
raised rolled edges and dilated
and irregular blood vessels
(telangiectasis) over its lateral
margin; with time it may erode
a large portion of the eyelid.

9. Malignant Tumor of the Eyelid
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Squamous Cell Carcinoma

10. Malignant Tumor of the Eyelid
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Squamous Cell Carcinoma
• SCC is much less common, but more aggressive tumor than BCC with
metastasis to regional lymph nodes in about of 20% of cases.
• Risk Factors: elderly individuals with a fair completion and a history of
chronic exposure, inmunocompromised.
• 5-10% of eyelid malignancies and may arise de novo or from pre-existing
actinic keratosis or carcinoma in situ.
• The diagnosis of SCC may be difficult because certain ostensibly benign
lesion such as keratocanthoma and cutaneous horn may reveal histological
evidence of invasive SCC at deeper levels of sectioning.

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• The tumor has a predilection for the lower eyelid and the lid margin.
• Tumor located at medial canthus are more prone to invade the orbit and
sinuses, are more difficult to manage than those arising elsewhere and carry
the greatest risk of recurrence.
Squamous Cell Carcinoma

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Clinical types
• The tumor may be indistinguishable clinically from a BCC but surface vascularization is
usually absent, growth is more rapid and hyperkeratosis is more often present.
Nodular SCC
Characterized by a
hyperkeratotic nodule which
may develop crusting
erosions and fissure.
Ulcerating SCC
Has a red base and sharply
defined, indurated, and
everted borders but pearly
margins and telangiectasis
are not usually present.
Cutaneous horn
with underlying invasive
SCC.

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Clinical types

14. Malignant Tumor of the Eyelid
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Sebaceous Gland Carcinoma

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Sebaceous Gland carcinoma
• SGC is a very rare slowly growing tumor which most frequently affects the elderly,
with a predisposition of females.
• In contrast to BCC and SCC, more commonly on the upper eyelid where the
meibomian gland are numerous.
• In about 5%: involvement of both lids on one side, probably due to intraepithelial
spread or to spontaneous development or multiple primary.
• The clinical diagnosis of SGC is frequently difficult because, in its early stages,
external signs of malignancy may be subtle, so that the tumor may resemble a
chalazion or blepharitis. However, the presence of yellowish material within the tumor
is highly suggestive of SGC.

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• It usually arises from the meibomian Gland, although in occasion it may
arises from the gland of Zeis or from sebaceous gland in the curuncle.
• SGC may arises from the glands of Zeis is though to have a more favorable
prognosis.
Sebaceous Gland carcinoma

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Nodular SGC
Presents as a discrete, hard nodule, most
commonly within the upper tarsal plate,
that may exhibit yellow discoloration due
to the presence of lipid.
Because the lesions may masquerade as a chalazion.
It is recommended that any Chalazion of an unusual consistency
should undergo full-thickness resection and histological
examination.
Spreading SGC
Infiltrates into the dermis and causes a diffuse thickening of the
lid margin that may result in loss of lashes and be mistaken for
‘Chronic blepharitis’.
Occasionally the tumor may exhibit multifocal non-contiguous
origins.
Clinical types

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Pagetoid spread
Extension of the tumor within epithelium including the palpebral,
forniceal or bulbar conjunctiva.
This may lead to the mistaken diagnosis of an inflammatory
condition.
Clinical types

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Melanoma

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Melanoma
• Cutaneos melanoma arises form the malignant proliferation of melanocytes.
• It can arise de novo or from a pre-existing nevus.
• Risk factors: Exposure of UV light, fair skin, the presence of dysplastic or congenital
nevi, family history of melanoma and older age.
• Types: Lentigo Maligna melanoma, Superficial spreading melanoma, Nodular
Melanoma and Acral lentiginous melanoma.
Lentigo Maligna melanoma
Most Common.
Atypical, mostly spindle-shaped melanocytes at basal
epidermis.
Extended to adnexal structures.

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Melanoma
Superficial Spreading melanoma.
Scattered or nest of epithelioid cells through epidermis.
Invaded dermis.
Nodular melanoma.
Vertical growth pattern
Composed of epithelioid type cells.

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Management & Treatment

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Management & Treatment
• Biopsy.
• Surgery

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