The eye can also be home to different types of neoplasms. Some of these may originate from the inner structures of the eye, such as retinoblastoma, a rare tumor in children developing from the nerve cells of the retina. Other tumors that may affect the eye and the peri-ocular region are epithelial tumors, as Dr. Alessandra Di Maria explains, ophthalmologist and contact person for orbit diseases, eyelids and tear ducts at Humanitas.
Non-melanoma skin tumors
Peri-ocular tumors fall into the broad category of neoformations, distinct from entities such as eyelid cysts that may be in stye, chalazion, sebaceous cysts etc. Malignant neoplasms from the periocular region account for 95% of eye cancers. They may occur throughout the region or originate from the paranasal sinuses. Pay attention to any new formations that do not recede and that present as nodular or ulcerative lesions”, warns the specialist.
The most common form is basal cell carcinoma, followed by spinocellular or squamous cell carcinoma, both skin tumors originating from deep skin cells: “The first – adds the expert – represents 85%-90% of all malignant cancers in the eyelid while spinocellular carcinoma represents 5%”.
The first type are known as “basaliomes” and, like squamous cell carcinoma, they often tend to form precisely on the skin of the face, which is most exposed to the action of the sun’s rays. Among the risk factors of these two cancers are also individual phenotypic characteristics, including the color of the skin. Individuals with light eyes, skin and hair have a higher risk if exposed to sunlight without protection.
A fundamental difference between these two cancers is that basalioma has a localized development at the place of origin, while squamous cell carcinoma can give rise to metastases. The evolution of basal cell cancer is slow and gradual, which allows for a rapid and decisive action to be taken.
Melanoma and adenocarcinoma
“1% of cases of periocular cancer are ocular melanoma. More rare, however, is the formation of a fourth type of malignant, very aggressive palpebral tumor, with a high risk of recurrence and an unfavorable prognosis. It is adenocarcinoma that can originate from the glands of the eyelids, whether sebaceous or not, and does not occur in the nodular or ulcerative form,” the specialist explains.
This, unlike other forms of cancer, affects the upper eyelid and the region of the tear gland in many cases, so “it must be evaluated with a magnetic resonance, a diagnostic examination that examines soft tissue”.
Diagnosis and treatment
Similarly to other neoplasms, early diagnosis is essential for skin cancers: “Depending on the location and type of tumor, a precise diagnostic and therapeutic procedure is used”.
Standard biopsy is not performed for all palpebral tumors: “In the case of basal cell carcinoma, all the tumor is removed by performing an excisional biopsy with intraoperative histological examination (freezing section technique). The patient is in the operating room, the tumor is removed and histologically evaluated margins are removed. It is important to perform histological examination of the free margins of the eyelid. If you are sure that the tumor has been completely removed, you can complete the operation with the reconstruction of the eyelid; otherwise you continue with a more radical intervention until the margins are free from cancer cells”.
For spinocellular carcinoma and gland carcinoma, biopsy is performed for histological examination and staging of the tumor. In the case of localized adenocarcinoma, the tumor is removed with massive craniofacial intervention, otherwise it is carried out differently in the case of metastases”.
Finally, melanoma: “The tumor is completely removed and the patient is subjected to staging of the tumor. The patient will follow a staging and subsequent follow-up checks, otherwise he will have to be treated according to the specific therapeutic protocol for melanoma,” concludes Dr. Di Maria.