Eyelid and Orbital Oncology

When Does a Skin Tag, Lump or Bump Warrant a Biopsy?

Skin tags can occur in childhood but become more common as one ages. Additionally, they are subject to hormonal changes and pregnant women experience new skin tags. Skin tags are typically an aesthetic concern and do not cause any further problems. However, they may have a relationship to diabetes and obesity so you should have your blood sugar and weight checked by your primary care physician if you notice a sudden onset of many skin tags.

Fortunately, skin tags are simple to remove. Usually these are removed using handheld cautery. In some cases excision is required with the use of a scalpel or special scissors. Control of bleeding and infection is extremely important. Therefore, only a physician should remove skin tags; do not try to do this on your own at home.
Any suspicious bump on or near your eyelid should be examined. There are a number of warning signs that indicate that the bump may be a skin cancer. These include the “ABCDEs:”

A: Asymmetry
B: Borders are irregular
C: Color variation (more than one color, new hypopigmentation (white discoloration) or hyperpigmentation (brown discoloration)
D: Diameter (size is greater than a pencil eraser)
E: Evolution (anything new – growth, bleeding, itching, loss of eyelashes, eyelashes in the wrong location)

Not all bumps are cancer. It may be a benign growth, infection or a sign of an underlying condition. Usually removal of the bump can be performed right in the office using a local anesthetic. Other cases require the equipment and safety of an operating room. After the bump is removed, you will likely be asked to apply an antibiotic ointment to prevent infection.

Eyelid Reconstruction for Cancer

The four most common cancer of the eyelids are basal cell carcinoma, squamous cell carcinoma, melanoma, and sebaceous cell carcinoma. Basal cell carcinoma is the most common eyelid cancer and sun exposure is the largest risk factor.

During your consultation with Dr. Cockerham, she will provide informed consent, answer your questions and schedule a biopsy of your suspicious bump and send it to a laboratory for histopathologic examination. If skin cancer is present, additional excision may be needed. Dr. Cockerham works in conjunction with MOHS dermatologists to obtain free margins and then reconstruct the affected eyelids. Depending on the type of cancer, additional treatments (radiation or chemotherapy) may be needed.

Skin Cancer: By the Numbers

Skin cancer is the most common form of cancer in the United States
Each year there are more new cases of skin cancer than the combined incidence of cancers of the breast, prostate, lung and colon
One in five Americans will develop skin cancer in the course of a lifetime
Basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) are the two major forms of non-melanoma skin cancer
- Between 40 and 50 percent of Americans who live to age 65 will have either skin cancer at least once.
- BCC is the most common form of skin cancer; about one million of the cases diagnosed annually are basal cell carcinomas. BCCs are rarely fatal, but can be highly disfiguring.
- SCC is the second most common form of skin cancer. More than 250,000 cases are diagnosed each year1, resulting in approximately 2,500 deaths.

Classic Risk Factors

Elderly caucasian
Light complexion/blue eyes
Actinic damage (sun damage)
Cigarette smoking

More Than 90% Of Non-Melanoma Skin Cancer Is Caused By Sun Exposure

Unprotected exposure
Outdoors even in the fog
Tanning booths
Through car, home or office windows
Yet only 33% of women and 10% of men wear daily sun block
Learn more about skin cancer.

Risk Factors Specific to Squamous Cell Carcinoma

HPV 16 and 18 (Human papilloma virus)
Immunosuppression (weakened immune system)
HIV – atypical, younger patients
Organ transplant
Xeroderma pigmentosum (a genetic skin disorder)
Predisposition for epithelial tumors

Incidence of Skin Cancers in the Young

Incidence:

Melanoma has tripled
Squamous cell carcinoma and basal cell carcinoma have doubled

1 in 5 Americans in their 20’s and 30’s will be diagnosed with skin cancer.

Men: are twice as likely as women to be diagnosed with skin cancer.

Skin Cancer Affects Non-Caucasians Too

Melanoma of the skin
Hispanic: birth to death risk
Male: .45 (1 in 221)
Female: .49 (1 in 205)

Skin Cancer MORE deadly for African Americans, Asians & Latinos

Caucasians
1974-1976: 81 %
1995-2001: 92 %
African Americans
1974-1976: 67%
1995-2001: 76%
Melanoma Surveillance, Epidemiology and End Results Program, 1975-2002, National Cancer Institute 2005; American Cancer Society, Surveillance Research, 2006

U.S. Skin Cancer Statistics

Incidence of has tripled since 1980
Early detection is crucial

What to Look For

History: Have you had prior skin cancer

If history of BCCA -> 50% have second lesion at 5 years
If history of SCCA -> 75% have second lesion at 5 years

Think beyond the face:

Women: lower legs
Men: back

Do you have:

Pain? (Usually painless)
Intermittent scaling or scabbing?
Irritation when wearing glasses?

Patient Education Gallery

Eyelid Skin Cancer

Basal Cell Carcinoma

Basal Cell Carcinoma Infiltrative Basal Cell Carcinoma Medial Canthal Basal Cell Carcinoma Ulcerative Basal Cell Carcinoma Umbilicated Basal Cell Carcinoma

Squamous Cell Carcinoma

Cystic Squamous Cell Carcinoma Squamous Cell Carcinoma

Eyelid Melanoma

Melanoma

Sebaceous Cell Carcinoma

Unusual Lesions

Keratoacanthoma Lentigo Maligna

Non-Cancerous

Capillary Hemangioma Cavernous Hemangioma Eccrine Cyst Epithelial Inclusion Cyst Trichofolliculoma Apocrine Hidrocystomas Compound Nevus Intradermal Nevus Verruca Vulgaris Papilloma Papilloma Seborrheic Keratosis

Orbital Cancer

Orbital Cancer in Adults
- Lymphoma
- Sarcoma
- Plasmacytoma
- Lacrimal Gland Cancers
  - Transitioned Pleomorphic Adenoma
  - Adenoid Cystic Carcinoma
- Metastatic disease

Orbital Cancer in Children

Rhabdomyosarcoma
Retinoblastoma

Multidisciplinary Cancers that Cause Visual Dysfunction

Sinus tumors
Brain tumors
Skin cancers