Some neoplasms can form in the internal structures of the eye, as is the case with retinoblastoma, a rare childhood tumor that originates from the nerve cells of the retina. Instead, epithelial tumors involve the eye and the periocular region.

We know the different types of cancer, how they are diagnosed and how they are treated with the help of Dr. Alessandra Di Maria, ophthalmologist and contact person for diseases of the orbit, eyelids and lacrimal glands at Humanitas.


Skin tumors other than melanoma

Periocular cancers fall into the category of neoformations. Malignant neoplasms originating from the periocular region represent 95% of the ocular tumors; they can occur in the whole region or form from the paranasal sinuses. “It is important not to underestimate a new formation that does not regress and that presents itself as a nodular or ulcerative lesion,” emphasizes Dr. Di Maria.

The most common form is basal cell carcinoma (which represents 85%-90% of all malignant tumors in the eyelid), followed by spinocellular or squamous cell carcinoma: these are skin tumors that originate from the deep cells of the epidermis and tend to form on the skin of the face, particularly exposed to sunlight. Risk factors include individual phenotypic characteristics such as skin color: People with light eyes, skin and hair are at greater risk if they are exposed to sunlight without adequate protection.

It should be noted that these two types of cancer present a fundamental difference: the basaloma has a development localized at the site of origin, while squamous cell carcinoma may give rise to metastases.


Ocular melanoma and adenocarcinoma

“In 1% of cases, periocular cancer is an ocular melanoma. Even more rare is adenocarcinoma, a very aggressive malignant eyelid tumor that can originate from the glands of the eyelids, either sebaceous or not; it has a high risk of recurrence and an unfavorable prognosis. This, unlike other forms of cancer, in many cases affects the upper eyelid and the region of the tear gland and should therefore be assessed with an MRI, the examination by which soft tissue is examined,” said the specialist.

Early diagnosis is also essential for skin tumors of the eyelids and, depending on the location and type of tumor, a precise diagnostic and therapeutic procedure is followed.


Treatment of Eyelid Tumors

“In the presence of a basocellular carcinoma, an excisional biopsy is performed with histological intraoperative examination (frozen section technique) in order to remove all of the tumor. The patient is in the operating room, the tumor is removed and the margins are histologically assessed. It is important to perform the histological examination of the free margins of the eyelid: in fact, 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 in order to completely free the margins from the tumor cells,” explains Dr. Di Maria.

In the case of spinocellular carcinoma and carcinoma of the glands, biopsy is performed for histological examination and staging of the tumor. “In the case of localized adenocarcinoma, the tumor is removed by a massive craniofacial intervention, otherwise the procedure is different in the case of metastases. Finally, in the presence of melanoma, complete removal and staging are carried out. The patient will follow a staging and subsequent follow-up controls otherwise he will have to be treated according to the specific therapeutic protocol for melanoma”, concluded Dr. Di Maria.