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  • Many types of skin cancer can affect the eyelid and periorbital region, with basal cell carcinoma and squamous cell carcinoma being the most common.

  • Surgical excision is usually curative, most commonly with Mohs micrographic surgery.

  • Novel drug classes such as Hedgehog inhibitors, BRAF inhibitors, and immune checkpoint inhibitors (PD-1, PD-L1, CTLA-4) may be of use in patients with locally advanced or metastatic disease.


  • Frozen section margin control is not adequate in malignant melanoma. Paraffin-embedded sections should be used instead.


  • Maintain a high index of suspicion for sebaceous gland carcinoma as it can mimic other common eyelid conditions.


  • Sun exposure is a critical factor in the development of many eyelid skin cancers.

  • Bleeding, growing, or nonhealing skin lesions around the eyelid should be evaluated by a dermatologist or ophthalmologist.


The eyelids are a dynamic part of the face that are involved in the protection and lubrication of the eye and ocular surface, as well as tear distribution and clearance. Thus, eyelids play a vital role in the visual function of the eye. Cutaneous malignancies of the eyelid and periorbital region are commonly seen. Management centers around successful treatment of the tumor and maintenance of eyelid form and function while striving to achieve the optimal aesthetic outcome.



Basal cell carcinoma (BCC) is the most common malignant periorbital and eyelid tumor. Ten to twenty percent of all BCCs are found in the eyelid and periorbital skin, likely due to the increased sun exposure of the region, and account for over 90% of all malignant eyelid tumors.1,2 The incidence of BCC worldwide varies significantly depending on patient demographics, total sun exposure, and proximity to the equator of the reported population. Although the rate of BCCs overall appears to be increasing, periorbital and eyelid BCC incidence rates may not be increasing at the same pace.2 Cook and Bartley reported an incidence of eyelid BCCs of 14.35 in 100,000 per year based on a Caucasian population in Olmsted County, Minnesota in 19993 that was nearly identical to the rate reported by Quigley et al in 2019 when assessing the Irish population between 2005 and 2015.4

Risk Factors

The most important risk factor for the development of BCC is ultraviolet (UV) radiation from sun exposure, coupled with low melanin or poor tanning ability. Low melanin characteristics associated with increased risk include pale complexion; blue or light color irises; red, blond, or light brown hair color; poor tanning ability, heavy freckling, or history of many sunburns. As such, the populations most at risk are those of European origin, particularly those of English, Irish, Scottish, and Scandinavian descent living in areas close to ...

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