Basal cell carcinoma is the most common type of eyelid cancer. It’s very unlikely to spread and is very treatable with surgery. Still, early detection is important.

Your eyelid helps protect your eyes, distribute tears, and support your vision by controlling the amount of light that enters your eyes. But like skin elsewhere on your body, especially sun-exposed areas, your eyelids are susceptible to skin cancer.

Basal cell carcinoma (BCC) is the most common type of cancer to affect the eyelid. It commonly occurs on the lower eyelid near the inner corner.

When BCC appears on your eyelid, it may look like a painless lump or ulcer that won’t heal. It can cause other symptoms like bleeding or excessive tearing.

BCC on the eyelid typically progresses slowly and rarely spreads to other body parts. However, without early treatment, it can lead to vision loss.

This article explores BCC on the eyelid, including its causes, risk factors, symptoms, diagnosis, and treatment.

Types of eyelid cancers

According to a 2023 study on the international prevalence of eyelid cancers, basal cell carcinoma is the most common type, accounting for 87.9%. It’s typically slow-growing and usually appears on the lower eyelid.

According to the study, other types include:

  • Squamous cell carcinoma: about 11.1% of all eyelid cancers
  • Sebaceous gland carcinoma: a rare type, making up about 5% of all eyelid cancer cases
  • Melanoma: the least common type, making up less than 1% of all eyelid cancer cases, but is more likely to grow and spread if untreated

BCC on the eyelid commonly appears on the lower lid. It can be mistaken for a stye or benign growth.

According to a 2017 review of medical literature, symptoms may include:

  • a persistent lump on the eyelid with a pearly or shiny appearance and a pinkish color
  • open sores that don’t heal and may bleed or appear crusty
  • a lump on the eyelid that can be seen or felt when the cancer spreads to the orbit (eye socket)
  • difficulty moving the eye or a decrease in the range of eye movement
  • ptosis (drooping of the upper eyelid)
  • epiphora (excessive tearing)
  • immobile eyelids

Diagnosing BCC on the eyelid involves several steps, which often include appointments with a dermatologist or ophthalmologist:

  • Medical history: A doctor starts by taking a detailed medical history, including any history of prolonged sun exposure, previous skin cancers, or family history of BCC. They will also ask about your symptoms.
  • Physical examination: The doctor will perform a thorough examination of the eyelid, looking for typical signs of BCC, such as a pearly or waxy bump, a flat, flesh-colored lesion, or an ulcer that doesn’t heal.
  • Biopsy: If the doctor suspects BCC, they will perform a skin biopsy. During the procedure, they take a small sample of tissue and examine it under a microscope to confirm the diagnosis.

The treatment for BCC on the eyelid depends on several factors, such as the tumor’s size, location, and depth.

The primary treatment for eyelid BCC is usually surgical excision, typically Mohs surgery due to its precision.

This procedure involves removing thin layers of cancerous tissue, which are then examined under a microscope until no cancer cells are detected, minimizing damage to healthy tissue.

In some cases, healthcare professionals may also consider other treatment options, such as:

  • oral or topical chemotherapy, including imiquimod (Aldara, Zyclara)
  • hedgehog pathway inhibitors, like vismodegib (Erivedge)

Like other skin cancers, the primary cause of BCC on the eyelid is long-term exposure to ultraviolet (UV) radiation, most often from the sun.

When the skin of your eyelids is repeatedly exposed to UV radiation, such as from tanning beds, it damages the DNA in the basal cells of the skin’s top layer, leading to uncontrolled growth and division of these cells.

People at risk of developing BCC on the eyelid may include people:

  • with prolonged exposure to UV radiation
  • with light skin, blond or red hair, or light-colored eyes
  • between 50 and 80 years old
  • assigned male at birth
  • who smoke cigarettes
  • with a family history of BCC

People with BCC on their eyelids typically have a very favorable outlook. It grows slowly and rarely spreads to other body parts.

Doctors can effectively treat most cases with surgery, leading to cure rates of 95% and recurrence rates of around 1% to 5% per year after surgical excision. Early diagnosis is important to prevent extensive tissue damage.

How serious is basal cell carcinoma on the eyelid?

BCC on the eyelid is typically not very serious because it grows slowly and rarely spreads. With surgery, cure rates can be as high as 95%.

However, because of its location on the eyelid, where it can limit eye function and appearance, early detection and treatment are crucial.

How long does it take to recover from basal cell carcinoma eyelid surgery?

The recovery time after BCC eyelid surgery can vary depending on the extent of the surgery. In general, initial healing may take a few weeks, with complete recovery taking a few months.

BCC on the eyelid is the most common type of eyelid cancer, but it’s also treatable, especially when detected early. Prolonged exposure to UV radiation is the leading cause. Certain people have a higher risk of developing BCC on the eyelid, including older adults and people who smoke cigarettes.