Due to the complex and rich anatomy of the periocular region, there is a wide variety of tumors that can occur in this area. Fortunately, the vast majority are benign and can be treated simply and without visible scarring. However, there are also a variety of malignant tumors that can affect the periocular region. In this section we will describe the most important aspects of the diagnosis and treatment of these malignant lesions
Basal cell carcinoma is by far the most frequent tumor at the palpebral level and is also the most frequent cancer globally in white people. It is directly related to sun exposure and usually occurs in people over the age of 40. Light skin is a very clear risk factor, while it is practically non-existent in black people. Mortality from basal cell carcinoma is extremely low as it has a relatively ‘benign’ behavior.
It is a cancer that does not spread (there are exceptions) and only produces local invasion. However, the local destruction it causes can be significant in structures as delicate and important as the eyelids. The most frequent location is the lower eyelid, followed by the inner canthus and the upper eyelid. Squamous carcinoma is the second most common cancer at the palpebral level. It is also related to sun exposure and is more frequent in fair-skinned people. It is a more invasive tumor than basal cell, since it causes greater tissue destruction, and can spread to produce metastasis.
It can also spread perineurally, that is, it can invade a nerve and follow its path to the orbit or the cranial cavity. The third tumor in frequency in our environment is sebaceous carcinoma. Historically, these tumors have been misdiagnosed or diagnosed late, as they have the characteristic of recurring stye or chalazion-type lesions. They can also present as chronic unilateral blepharoconjunctivitis that does not improve with treatment. Today, ophthalmologists and pathologists are more familiar with this tumor, but it is still very common for this tumor to be diagnosed late. Sebaceous carcinoma has a high tendency to invade locally and to metastasize. Unfortunately, late diagnosis of these tumors leads to a clear decrease in the survival rate, and this has been demonstrated in studies. It also has a high tendency to spread superficially through the conjunctiva. This form of dissemination is called a pagetoid invasion. There are many other tumors that can affect the periocular region less often. These include melanoma, Merkel cell carcinoma, sarcomas, lymphomas, etc.
Patient with lower eyelid basal cell carcinoma treated with cryotherapy (cold), without surgery. Appearance before and after treatment.
In general, with surgery, since complete removal of a localized tumor is curative. In advanced cases a combination with other treatments may be necessary. In cases of small basal cell or squamous cell carcinomas, we can sometimes treat them without surgery by applying cryotherapy or special creams. Given the anatomical complexity of the eyelids and their important eye protection function, it is essential that the treatment be performed by a specialist in oculoplastic surgery. In complex cases, we may require the collaboration of a dermatologist specializing in Mohs surgery, which ensures complete removal of difficult tumors with maximum preservation of healthy tissue. The first goal of surgery is complete removal of the tumor by sacrificing as little eyelid tissue as possible. The second objective is to ensure that the eyelid will have proper function and cosmetics after surgery. This is achieved through very specific techniques that require extensive knowledge of periocular anatomy. Even in cases where we must dry almost the entire eyelid, it is possible to achieve a very acceptable aesthetic and functional result.