Malignant eyelid lesions can be identified by the eye care provider, primary care provider, or dermatologist during a routine exam. The most common malignancies of the eyelid include basal cell carcinoma, squamous cell carcinoma, sebaceous cell carcinoma, melanoma, and Merkel cell carcinoma.
Other eyelid malignancies exist, but these are rare and beyond the scope of this article. It is crucial to remember that any cutaneous malignancy can occur in the periocular region, and physicians should perform a thorough history and physical exam with all new patients.
The patient history should include questions regarding predisposing factors, duration, and rate of lesion growth, symptoms of tenderness, discharge, or bleeding, combined with careful clinical observation. A past medical history of skin cancer, UV exposure, and non-healing or recurrent cutaneous lesions should heighten suspicion of periorbital skin malignancy. Examination under magnification using a slit-lamp or dermoscopy is helpful in better characterization of any suspicious lesion. Notably, dermoscopy can reduce the need for unnecessary surgical procedures.
When there is a suspicion of malignancy, a referral should be made for a biopsy and histopathological analysis. When indicated, treatment consists of surgical excision, radiotherapy, chemotherapy, immunotherapy, cryosurgery, or laser treatments.
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