TREATMENT-Eyelid Cancer

Treatment

The treatment of eyelid cancer varies depending on the type of cancer and the tumor's location. Doctors may use a combination of treatments in order to effectively remove the cancer and reduce the chance of it spreading. A team of specialists may help plan appropriate treatment. They may include a dermatologist (a doctor who specializes in diseases and conditions of the skin), surgeon, radiation therapist, ophthalmologist, and medical oncologist.

Surgery

Different types of surgical procedures are used depending on the size of the cancer and where it is located. Extensive surgery may result in scarring and deformity of the eyelid, enucleation (removal of the eye), and/or may cause problems with tear drainage.

Biopsy. A surgical biopsy may remove part of the tumor (incisional) or the entire tumor (excisional). If the tumor is found to be cancerous, and the surgeon has removed a sufficient margin of healthy tissue along with the tumor, the excisional biopsy may be the only treatment needed.

Mohs' surgery. This technique involves removing the visible tumor, in addition to small fragments of the edge of where the tumor existed. Each small fragment is examined under a microscope until all cancer is removed. This procedure is most often used for larger tumors, those in hard-to-reach places, and for cancers that have recurred (come back) in the same place; however, it is increasingly becoming a preferred technique for removing all types of eyelid tumors. Following Mohs' surgery, reconstruction may be necessary by an ophthalmologist or plastic surgeon trained in ocular (eye) reconstructive procedures.

Cryosurgery. Cryosurgery, also called cryotherapy or cryoablation, uses liquid nitrogen to freeze and kill cells. The skin will later blister and slough (shed) off. This procedure will sometimes leave a white scar. More than one freezing may be needed.

Radiation therapy

This procedure, which uses high-energy x-rays or other particles to kill cancer cells, may be used for a cancer that is hard to treat with surgery. Several treatments may be needed. The treatment may produce a rash, make the skin dry, or change the color of the skin.
External-beam radiation therapy delivers radiation from a machine outside the body directly to the tumor and may be given as a primary treatment, after enucleation, or as a palliative treatment (care given to improve quality of life by treating symptoms and side effects of the cancer or its treatment).

Radiation therapy may result in a variety of side effects, so it is important to talk with your ophthalmologist or oncologist about what to expect. The extent of side effects depends on the type and dose of radiation therapy the patient receives, where the tumor is located, and the patient's general health. Some side effects (listed below) may not show up right away.
Cataracts. Cataracts are very common. A cataract occurs when the lens of the eye becomes cloudy. People with cataracts may have cloudy or foggy vision, have trouble seeing at night, or have problems with glare from the sun or bright lights. If the cataract is causing major problems with a person's eyesight, it can be surgically removed.

Loss of eyelashes and/or a dry eye. Loss of eyelashes and/or a dry eye can occur with radiation therapy. Some treatment options for this condition includes over the counter eye drops, prescription eye drops such as Restasis (cyclosporine ophthalmic), and plugs that can be placed in the tear ducts. Talk with your ophthalmologist about how to manage these side effects.
Change in lid position. After radiation therapy and/or surgery, the eyelid may roll inward (entropion) or sag outward (ectroption). Either condition may affect eye health and can be repaired with surgery.

Other common side effects. Other common side effects from radiation treatment include red eye, tearing, and sensitivity to light.

The following side effects are much less common and can cause a loss of vision:

Radiation retinopathy. Radiation retinopathy is the development of abnormal blood vessels in the retina, which is the thin-layered structure that lines the eyeball.
Radiation optic neuropathy. Radiation optic neuropathy is radiation-induced optic nerve damage.

Neovascular glaucoma. Neovascular glaucoma is a painful condition that involves new blood vessels developing and blocking the regular release of fluid from the eye.

If there is significant damage to the eye from radiation therapy, the eye may need to be removed.

Advanced eyelid cancer

In rare cases, melanoma, squamous cell carcinoma, or sebaceous carcinoma can spread to other parts of the body.

If the cancer has spread to nearby areas, such as the tumor invading the sinuses or brain, radical surgical resection (extensive surgery) may be an option.

Surgery alone is not effective in treating eyelid cancer that has metastasized to distant parts of the body. To control this distant spread, chemotherapy, immunotherapy (also called biologic therapy, designed to boost the body's immune system by using materials either made by the body or in a laboratory to bolster, target, or restore immune function), or radiation therapy may be necessary.