The eyelid is the protective shield and the cosmetic, charm of the human eye (see Chapter 2). It consists of, layers of tissue, each of which can give rise to benign and, malignant tumors. This chapter outlines the epidemiology,, differentiating features, and diagnosis of the most, common benign and malignant eyelid tumors (Mind, maps 36-1 to 36-7)., Eyelid cancer constitutes 5%–10% of all skin cancers, the, 4 most common being BCC, SCC, SGCa, and melanoma, (Fig. 36-1). It is important to note that nearly 82%–98%, of all eyelid tumors are benign.1-3 For example, squamous, papilloma, seborrheic keratosis, keratoacanthoma, and, nevi are common benign epithelial tumors of the eyelid., Benign tumors are also more prevalent in the younger, age groups, e.g., dermoid and epithelial tumors comprise, the majority of childhood adnexal tumors.1 Most eyelid, tumors are visible and easily recognized early by the, patient or the parent., Challenges to diagnosis and management include:, • Older patients often ignore and delay seeking medical, attention., • Involvement of the lid margin and palpebral conjunctiva, go unnoticed., • Malignant lesions can simulate benign conditions., • The eyelid structures are in proximity with the orbit,, allowing contiguous extension., • The lymphatic and vascular supply of the head and, neck allow potential routes of metastasis., • Extensive surgery with wide margins can result in, unacceptable functional and cosmetic results., Eyelid tumors can be classified based on tissue of origin, as benign or malignant (Table 36-1). However, in, clinic it is helpful to divide them into melanocytic or, nonmelanocytic (Mind maps 36-1, 36-2). AJCC staging, provides prognostic TNM information that assists, patient management.1,3
Chapter Keyword: eyelid
Treatment of Eyelid Tumors
The treatment of tumors of the eyelid is both complex, and fascinating. The choice of treatment depends upon, the type of tumor (benign, malignant, specific diagnosis),, size, location (upper or lower eyelid, canthus involvement,, deeper involvement to ocular surface or orbit), the, age and systemic health of the patient, and the surgeon’s, preference (see Chapter 2).1, For appropriate management, the basic oncological principles, must be followed:, • Adequate tissue biopsy for diagnosis., • Assessment of tumor margins., • Evaluation for local and systemic spread., In Chapter 36 we discuss the clinical features of common, eyelid tumors. Herein we discuss the management,, including surgery, radiation, cryotherapy, PDT, and, chemotherapy (Mind Map 37-1). We also provide a broad, overview of reconstructive techniques following excision, and the prognosis of common eyelid malignancies.
Functional Ophthalmic Oncology Anatomy
Anatomic and tumor-specific factors play dominant roles in clinical decision-making. Select examples include eye¬lid tumor position directing the postresection method of repair (see Chapter 37), orbital optic nerve sheath obstruction requiring slotted plaques (see Chapter 18) to completely cover juxtapapillary intraocular tum¬ors, and the shape of the orbit affecting the orbitotomy approach. In consideration of the basic anatomy of the eyeball, the adnexa, and the orbit, this chapter high¬lights select salient anatomical features that affect tumor growth, metastasis (regional or distant), diagnosis, and management.
