Treatment of Eyelid Cancer

Executive Summary

Treatment recommendations depend upon the size, grade and type of tumor, metastasis, possible side effects, and patient’s preferences and overall health. The common treatment for eyelid cancer involves surgery (biopsy, Moh’s surgery, cryosurgery, reconstructive surgery), removal of eye, radiation therapy (external-beam radiation therapy), and chemotherapy (fluorouracil). Palliative care includes medication, nutritional changes, emotional and spiritual support and other relaxation therapies.

Treatment of Eyelid Cancer

“Standard to care” refers to the best-known treatment. In cancer care, different doctors work together to bring out an overall treatment plan for the eyelid cancer patient. This is called a multidisciplinary team. 

Treatment options and recommendations for eyelid cancer usually depend on several factors, including the type, stage and grade of cancer, possible side effects, and patient preferences and overall health.

The main target for treating intraocular melanoma is to reduce the risk of the tumour spreading and maintain the vision and health of the patient’s eye, if possible.

Surgery

Surgery is the removal of a tumour and surrounding healthy tissue during an operation. An ophthalmologist typically performs eye surgery. During surgery, the ophthalmologist removes parts or all of the affected eye depending on the size and spread of the tumour.

Extensive surgery may result in scarring and deformity of the eyelid, enucleation (removal of the eye), or may cause problems with tear drainage ^​1​. Talk with the doctor before surgery about the possible side effects of your surgery, including changes to your vision and appearance, as well as physical and psychological support services available to you for your recovery.

• Biopsy – A surgical biopsy may remove part of the tumor (incisional) or the entire tumor (excisional). Suppose the tumor is found to be cancerous, and the surgeon has removed a sufficient margin of healthy tissue along with the tumor. In that case, an excisional biopsy may be the only treatment needed. 
• Mohs’ surgery – This technique involves removing the visible tumor and small fragments of the edge of where the tumor existed. Each small fragment is examined as microscope until all cancer is removed. This procedure is often used for a larger tumor, a tumor in a hard-to-reach place, and for cancer that has come back to the same place. However, it is increasingly becoming a preferred for removing an eyelid tumor. After Mohs’ surgery, a patient may require reconstructive surgery by an ophthalmologist or plastic surgeon trained in ocular (eye) reconstructive procedures to retain the function of the eye.
• Cryosurgery – Cryosurgery uses liquid nitrogen to freeze and kill cells, also called cryotherapy or cryoablation. The skin will later blister and shed off. This procedure can sometimes leave a pale scar, and patients may need more than one freezing procedure.
• Reconstructive surgery – Many patients with eyelid cancer need reconstructive surgery. Reconstructive surgery is different from cosmetic surgery in that it is generally performed to improve eye function, although it may also be done to approximate a normal appearance. Often, multiple surgeries are done, spread out over some time. Cosmetic surgery is performed on typical structures for appearance. A surgeon may use skin grafts to reconstruct the eyelid and give patients a normal appearance completely.

Having an eye removed

Sometimes, a doctor’s only choice in treating intraocular melanoma is to remove the eye. A person with one eye can have trouble with depth perception because of vision loss. Most patients adjust to the differences.

Many people get tensed about what they will look like when an eye is removed. The cosmetic surgery available usually yields good cosmetic results. The person is fitted for an artificial eye (prosthesis) to fill the area left by the missing eye. The prosthesis will behave and look almost the same as a natural eye. For instance, the artificial eye will move with the person’s other eye, just not as the natural eye moves. 

If enucleation is required, talk to the doctor about a prosthesis as early as possible. It may take many weeks to receive one. 

Radiation Therapy

A doctor specializing in giving radiation therapy to treat cancer is a radiation oncologist. A radiation therapy schedule consists typically of a specific number of treatments for eyelid cancer offered over a set period.

The most common radiation treatment type is external-beam radiation therapy, in which radiation is given from the machine outside the body ^​2​. 

Radiation therapy may be used for eyelid cancer hard to treat with surgery, and several treatments may be needed. Eyelid cancer treatment side effects may include dry or discolored skin, rash, fatigue, upset stomach, mild skin reactions, or loose bowel movements. Most side effects go away soon after treatment ends. However, other side effects may show up later, such as those listed below.

Treatment for eyelid cancer using radiation therapy is improving continually. Talk with the doctor about the risks and benefits of the different types of radiation therapy. Side effects may include:

• Cataracts – Cataracts are prevalent. A cataract is when the eye lens becomes cloudy. People with cataracts may have a cloudy or foggy vision, have trouble seeing at night, or have problems with glare from the sun or bright lights. If the cataract is causing significant problems with a person’s eyesight, it may be surgically removed.  
• Loss of eyelashes or a dry eye – Losing eyelashes or a dry eye can happen with radiation therapy. Some eyelid cancer treatment options include over-the-counter eye drops, prescription eye drops like cyclosporine ophthalmic (Restasis), and plugs that may be placed in the tear ducts. 
• Change in lid position – After radiation therapy or surgery, the eyelid may roll inward (entropion) or sag outward (ectroption). This condition may affect eye health and can be repaired with surgery.
• Radiation keratopathy – Exposure to high energy x-rays to the eyelid can cause a disease of the eye’s cornea, known as keratopathy. This can cause damage to the top layer of the eye and damage the cornea.
• Other common side effects – Other common side effects from radiation therapy include tearing, red-eye, and sensitivity to light.

The mentioned side effects are much less common and can cause a loss of vision:

• Radiation retinopathy develops abnormal blood vessels in the retina, the thin-layered structure that lines the eyeball.
• Radiation optic neuropathy – Radiation optic neuropathy is radiation-induced optic nerve damage.
• Neovascular glaucoma – Neovascular glaucoma is a painful condition that involves new blood vessels developing and blocking the regular release of fluid from the eye.

Chemotherapy

Chemotherapy uses medicine to kill or stop the growth of cancerous cells. Depending upon the stage, different chemotherapy is given. The point that makes a difference is how the chemotherapy enters the body and which cells it affects.

Standard methods for chemotherapy include an intravenous (IV) tube placed into a vein using a needle or by capsule or pill taken orally.

A chemotherapy schedule usually consists of a certain number of cycles over a fixed period. A patient can be given one drug at a time or a combination of different medications given simultaneously.

Chemotherapy is most commonly a topical therapy for eyelid cancer, which is placed directly on the affected skin. Topical chemotherapy can be prescribed by a medical oncologist, a doctor specializing in treating cancer with medication, or an ophthalmologist or dermatologist.

The most common topical chemotherapy is fluorouracil (Efudex) ^​3​. A patient puts a skin cream or solution on the affected area. It may be an alternative to surgery, especially for patients with a smaller tumour.

The side effects of topical fluorouracil include pain, dryness, irritation, burning, itching, or swelling where applied. Sometimes people experience sensitivity to sunlight and scarring or discoloration of the skin. These side effects go away once eyelid cancer treatment ends.

Palliative Care for eyelid cancer

Cancer and its treatment have side effects that can be mental, physical or financial and managing the effects are palliative or supportive care.

Palliative care includes medication, nutritional changes, emotional and spiritual support and other relaxation therapies. 

Palliative care focuses on alleviating how you feel during treatment by managing symptoms and supporting patients and their families with other non-medical needs. Regardless of type and stage of Cancer age, any person may receive this type of care.

Metastatic eyelid cancer

If cancer has spread to distant parts of the body, it is known as metastatic cancer. Rarely, squamous cell carcinoma, melanoma, or sebaceous carcinoma may spread to other body parts.

The health care team may suggest a treatment plan that includes surgery, radiation therapy, and chemotherapy. If cancer has spread to nearby areas, such as the tumour invading the sinuses or brain, radical surgical resection (extensive surgery) may be an option.

However, surgery alone is not practical for eyelid cancer metastasizing to distant parts of the body. Immunotherapy, chemotherapy, targeted therapy, or radiation therapy may be necessary to control the disease at this stage. Immunotherapy, also known as biologic therapy, is designed to boost the body’s natural defences to fight cancer. It uses substances formed either by the body or in a laboratory to bolster, target, or restore immune system function.

Remission and the chance of recurrence of eyelid cancer

When cancer can’t be detected in the body and there are no symptoms, this is known as remission. This may also be known as having ‘no evidence of disease’ or ‘NED.’

A remission may be temporary or permanent. Many people worry about the recurrence of cancer.

If eyelid cancer treatment doesn’t work

Recovery from bone sarcoma is not always possible. If cancer can’t be treated or controlled, it leads to advanced or terminal cancer. It is vital to have straightforward conversations with your health care team to express your feelings, preferences, and concerns. The health care team has unique skills, knowledge, and experience to assist patients and their families. Ensuring that a person is physically comfortable, free from pain, and emotionally supported is extremely important. 

References