Most ‘lumps and bumps’ appearing around the eyelid are benign growths that are not skin cancers. These include skin tags, age-related warts (seborrheic keratosis), styes (chalazion), skin cysts (hydrocystomas) and moles (naevi).
Skin cancers can appear like any skin lump or bump in the early stages. There tends to be slow growth, redness or a change in the shape of the eyelid with time. There is usually no pain but sometimes the eyelashes will fall out or the area will bleed by itself.
By far the most common skin cancer around the eyelids is a basal cell carcinoma (BCC). If left untreated a BCC will grow in size, eroding and damaging the skin and structures around it. A BCC does not metastasize to other parts of the body.
The longer the skin has been exposed to sunlight (i.e. ultraviolet radiation) the more likely it is that a skin cancer can occur. As Australia is a very sunny place, skin cancer more common among Australians with fair skin. Risk factors include:
- a high level of sun exposure
- getting older
- fair skin, freckles
- having had a previous skin cancer.
Most skin cancers around the eyelid are cured with surgery. This is the most reliable way to completely remove the skin cancer and has an excellent success rate. In some special circumstances, other non-surgical options (cryotherapy, radiotherapy, immunotherapy) may be considered, but usually only if surgery is not a possibility.
Losing vision, or even an eye, is very uncommon due to a skin cancer around the eye. This is, however, a possibility if a skin cancer is ignored.
The aim of surgery is to completely excise the skin cancer, protect the eye, and reconstruct the eyelid as close as possible to its normal appearance and function. The complexity of the surgery will depend on the size of the skin cancer and where it is located on the eyelids.
- A biopsy may be required of the skin lesion to confirm the diagnosis before planning for surgery. This is usually done during the consultation in a treatment room
- The surgery is done as a day case procedure with a twilight anaesthetic (intravenous sedation) and local anaesthetic, making the procedure painless. Occasionally a general anaesthetic may be used.
- Most procedures take 60 to 90 minutes.
- The skin cancer is excised for pathology and is often analysed on the day (frozen section pathology).
- An eyepad may be needed for 1 to 7 days
- Bruising of the eyelid can be very obvious for the first week.
- Patients can resume driving 24 hours after the surgery (if they are no longer wearing an eyepad) and can return to their usual routine after several days.
- It may be a week to 10 days before active exercise (swimming, lifting weights) is resumed, but light exercise (eg walking) is encouraged from the first day.
Some skin cancers are very hard to see, or may involve a large amount of the eyelid and pose special challenges. In these cases:
- Removing the skin cancer may be done as a separate procedure by a specialist dermatologist Mohs surgeon. The reconstruction of the eyelid is done several days later.
- The reconstruction of the eyelid may involve two separate operations done two weeks apart. During this time the eyelid is closed and there is no driving allowed.
Most cases have excellent outcomes with a normal looking eyelid and complete removal of the skin cancer.
- It may take some time (months) for the healing to be complete. The larger the skin cancer the greater the challenges posed. The eyelid can be red, swollen or have an altered shape for many weeks.
- There are some cases in which the eyelid is altered in its final appearance or has healed in an unexpected manner. Further reconstructive surgery may need to be considered months after the original surgery.
- Bleeding, chronic pain and infection of the eyelid is quite rare, but some patients will have watering and discomfort for the first two weeks after surgery.
- There may be permanent loss of eyelashes in the area of the surgery.
- Recurrence of the skin cancer is rare (if it has been completely removed).
- Altered vision or damage to vision is rare.
- Eye watering can be a problem if the tear duct system (lacrimal system) has been affected by the skin cancer or surgery. Further surgery may be an option to help this.
The aim is to reduce the amount of sunlight on the skin, especially if you have pale skin, freckles or red hair.
- When outdoors, wear protective clothing such as long sleeve t-shirts, hat, and sunglasses.
- Avoid long periods in direct sunlight (e.g. use shade umbrellas at the beach).
- Always apply a high protective sunscreen (at least UPF 30) and do so every 2 hours whilst in the sun.
- If you notice a suspicious skin change, see your GP or a dermatologist, and have regular check ups if you have had a skin cancer before.