The high sensitivity of an eyelid makes it vulnerable to cancerous growth. About 5 to 10 percent of all skin cancers occur on this part of the eye.

Squamous cell carcinoma (SCC) has the second-highest occurrence rate of all eyelid cancers. It follows basal cell carcinoma, the most common type of skin cancer on the eyelid.

Your risk of developing SCC is low if you live in a high-latitude area further away from equator. There, it affects about 0.02 people for every 100,000.

SCC occurs more frequently in low-latitude, high-sun regions around the equator. Its prevalence rate there is roughly 3.5 per 100,000 people.

Like all eye cancers, SCC affects more men than women.

woman hazel eyes

What Is Squamous Cell Carcinoma of the Eyelid?

Squamous cell carcinoma of the eyelid is a type of tumor that develops on the eyelid because some abnormal cells on the affected skin area are growing uncontrollably.

The cancerous growth can cause noticeable damage, including loss of normal eyelid features. There are strong links between this condition and factors like radiation and sun exposure.

While SCC is treatable, early diagnosis and treatment are necessary to improve the person’s long-term prognosis. Like many cancers, this one is invasive. It will spread to other parts of the eye and other part of the body if not detected early enough for treatment to take hold.

Signs and Symptoms

Squamous cell carcinoma symptoms/signs include:

  • A mass or nodular skin lesion (early symptom)
  • Nodule may bleed at later stages
  • Itching
  • Pain
  • Larger than normal lesions over time
  • Ulcers at later stages
  • Multiple nodules in other body parts due to metastasis

Stages

Eyelid SCC progresses through multiple stages. Each stage sets the course for a separate and appropriate treatment plan. The main stages are:

Stage 0 (Carcinoma in Situ) The tumor is on the original site and hasn’t spread to the tarsal plate (dense connective tissue making up your eyelid). It’s potentially invasive, though.
Stage IA The tumor is growing but is 5 mm wide or smaller and hasn’t invaded the main structure of the eyelid.
Stage IB Tumor is between 5 mm and 10 mm wide or has spread to the tarsal plate. It hasn’t invaded nearby tissues or other body regions yet.
Stage IC Tumor is 20 mm wide or smaller or has invaded the whole dense structure of the eyelid. Surrounding lymph nodes and other areas of the body remain unaffected.
Stage II The growth is larger than 20 mm or has invaded surrounding parts of your eye. It hasn’t impacted nearby lymph nodes and other body areas.
Stage IIIA

 

The cancerous mass is now bigger. To cut it out, your surgeon has to remove the eye and the surrounding tissues.

It hasn’t invaded nearby lymph nodes or other body regions.

Stage IIIB Metastasis has occurred (growth has invaded the surrounding lymph nodes). Other body areas are unaffected for now.
Stage IIIC There’s cancerous growth beyond your eye area. The tumor may or may not have invaded regional lymph nodes.

Surgery isn’t an option here because of the extensive damage to skin around the eye. Tumors haven’t spread to distant parts of the body.

Stage IV Metastasis to distant regions of the body has occurred. The malignant growth can be any size now.
Recurrent Tumors return following treatment. They may develop in any body organ, including the eye.

Causes

Prolonged exposure to the sun’s ultraviolet radiation is a major risk factor for developing SCC of the eyelid. This is why this type of cancer (and other types of skin cancer) affect more people who live or have traveled around the equator.

Other predisposing factors include:

  • Chronic ulcers
  • HIV infection
  • Previous skin cancer
  • Bowen’s disease
  • Old burns
  • Use of immune suppressing drugs
  • Fair, delicate skin

Diagnosis

Your doctor will first examine your lesion for indications like size, bleeding, or inflammation. They’ll also consider any predisposing factors applicable to you, such as previous radiation exposure, skin cancer, or burn scars.

You may undergo diagnostic tests like:

  • Computed tomography (CT) or magnetic resonance imaging (MRI) scans
  • Biopsy (A small sample of the growth is removed for lab tests)

Treatment

The size and stage of your eyelid tumor will determine the best treatment for you. Be sure to discuss your options with your doctor to establish realistic expectations. Feasible treatments for SCC include:

  • Biopsy: The surgeon will make a tiny incision to remove the growth. This procedure is suitable for small lesions that haven’t spread all over the eyelid.
  • Mohs surgery: With this procedure, the surgeon extracts the cancerous cells layer by layer until the last one is removed.
  • Chemotherapy: These are drugs you take to destroy the cancerous cells throughout your body. It’s suitable for cancer that has invaded other parts of the body.
  • Radiation: Your doctor may recommend destroying your malignant growth using high-energy beams like X-ray.
  • Cryotherapy: Here, low-temperature nitrogen is used to kill the cancer cells. This targeted therapy is used to treat non-invasive growth.
  • Reconstruction: Invasive procedures like surgery can alter the structure and function of your eyelids. To restore your facial aesthetics and eyelid function, you may need reconstructive surgery.

The best outcomes for this type of eyelid cancer come when a surgeons can excise, or cut out, the offending lesion(s) or tumor(s).

Recovery After Treatment

Recurrence of this kind of cancer is rare. However, cancer can return after treatment, so follow-up with your doctor for checkups is important. You can do this annually to be able to spot and remove any recurring tumor early. Doctors recommend lifelong screenings for the cancer.

During these exams, your doctor may conduct biopsies at the original site of the growth and the surrounding lymph nodes. Any tissue that takes longer than usual to heal is a potential target for further testing.

Your doctor may recommend an aggressive treatment plan if follow-up biopsies detect new lesions.

Outcomes

Squamous cell carcinoma of the eyelid has a promising outlook if detected and treated early. Detection at a stage before your cancer has migrated to other parts of your body gives you more treatment options. It also increases the possibility of removing all cancerous cells from your body with minimally invasive incisions.

Early detection leads to the most successful outcomes. One study from 2002 followed 50 patients with this eyelid cancer from 1992-2001. Only one patient died, and that patient declined treatment.

Bottom line: if you notice a lesion or lump on your eyelid, see a doctor before it starts to bleed or irritate.

Also, the risk of your SCC recurring is much lower when you consistently observe appropriate precautions. These include wearing sunscreen and minimizing your sun exposure.

References

Treatment Options and Future Prospects for the Management of Eyelid Malignancies: An Evidence-Based Update. (November 2001). Ophthalmology.

Incidence of Squamous-Cell Carcinoma of the Conjunctiva and Other Eye Cancers in the NIH-AARP Diet and Health Study. (May 2012). Ecancermedicalscience.

Squamous Cell Carcinoma of the Eyelid. (2022). American Academy of Ophthalmology.

Squamous Carcinoma of the Eyelid. (2022). American Academy of Ophthalmology.

Orbit, Eyelids, and Lacrimal System. (June 2015). America Academy of Ophthalmology.

Squamous cell carcinoma of the eyelids. (October 2002). Journal of Opthalmology.

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