Basal cell carcinoma is a form of skin cancer that arises from basal cells. Basal cells are small round cells in the bottom layer of the epidermis (= epidermis). Basal cell carcinoma is often located on the head, face (especially the nose), neck, trunk, limbs and genitals. However, this form of skin cancer also occurs in the eyelid. A patient presents with a red lump on the eyelid. He also often loses eyelashes. Most basal cell carcinomas hardly spread and can easily be removed surgically. The outlook for patients with this malignant tumor is excellent in most patients.
- Synonyms basal cell carcinoma
- Epidemiology
- Causes: Exposure to sun
- Risk factors for skin cancer in the eyelid
- Symptoms: Lump on eyelid, with loss of eyelashes
- Diagnosis and examinations
- Treatment by surgery
- Complications
- Prognosis
- Prevention of malignant tumor
Synonyms basal cell carcinoma
Basal cell carcinoma (BCC) is also known as:
- a basalioma
- a basocellular carcinoma (cancer of the skin, mucous membranes and organs)
Epidemiology
People with a light skin type, who have red or blond hair, freckles, burn easily and never tan, are affected more often than people with a dark skin type. Skin cancer also occurs more often in patients with blue eyes (eye color). Caucasians of Celtic ancestry also have the highest risk of developing basal cell carcinoma. The incidence is lowest in black-skinned patients, Asians and Hispanics. Men are also affected twice as often as women, perhaps because they are exposed to the sun more and more often, a risk factor for developing this type of skin cancer. Furthermore, patients are most commonly affected between the fifth and eighth decades. Finally, basal cell carcinoma is the most common malignant eyelid tumor (eyelid cancer).
Causes: Exposure to sun
Ultraviolet light causes damage to the epidermis. As a result, basal cell carcinoma develops in some people. Genetic factors play a role in a number of patients. For example, defects in the PTCH gene on chromosome 9q22.3 are associated with the development of basal cell carcinoma.
Risk factors for skin cancer in the eyelid
Basal cell carcinoma develops in lightly pigmented patients in areas exposed to the sun. Other risk factors are: irradiation (radiotherapy), a suppressed immune system, previous scars and hereditary syndromes, such as xeroderma pigmentosum (symptoms in the eyes, skin and brain under the influence of sunlight irradiation).
Symptoms: Lump on eyelid, with loss of eyelashes
Due to a relatively large amount of sun exposure, basal cell carcinoma has a predilection for the lower eyelid, followed by the medial canthus (corner of the eye towards the nose), as well as occasionally for the upper eyelid. The patient with basal cell carcinoma usually notices a red lump on the eyelid that grows slowly. In addition, the patient may experience tingling or numbness around the tumor. He also loses eyelashes, which is an indication of a malignant tumor. The loss of eyelashes is known in medical terms as ‘madarosis’. The patient also has a skin lesion with crusting that does not heal. Ulcers and bleeding also occur. Some patients are completely asymptomatic.
Diagnosis and examinations
Ophthalmological examination
The patient receives a complete eye examination, during which the ophthalmologist examines the eye movements. The doctor also assesses the feeling in the face. When examining the injury, the doctor looks for the following symptoms:
- the presence of skin ulcers
- the deformation of the eyelid structure or an incorrect position of the eyelid
- the general appearance and extent of the lesion and eye skin
- madarosis (medical term: loss of eyelashes and/or eyebrows)
- telangiectasia (skin condition with dilated blood vessels)
Diagnostic research
A biopsy of the eyelid confirms the diagnosis of basal cell carcinoma.
Differential diagnosis
The differential diagnosis includes all benign or malignant conditions involving the eyelid skin, including:Benign
- actinic keratosis (skin lesions due to sun exposure)
- blepharitis (inflammation of the eyelid margins)
- a chalazion (harmless hard bump in the eyelid margin)
- a cyst (abnormal fluid-formed bladder-shaped cavity in the body)
- a nasopharyngeal angiofibroma (a benign blood vessel tumor of the nose and throat)
- a nevus (birthmark)
- a wart (benign, painless growths on the skin)
- a squamous papilloma (benign scaly epithelial growth (with nipple-like elevations))
- a wart
- molluscum contagiosum (infectious soft wart-like growth about the size of a pea with a depression in the middle containing a white pulpy mass)
- psoriasis (chronic skin disease with dry skin and flakes)
- xanthelasma (yellow bump that appears around the eyes)
Evil
- Bowen’s disease (skin condition: precancerous stage of skin cancer) (similar to eczema (chronic skin disease with dry skin and itchy skin), containing cells of malignant structure)
- a lymphoma (malignant proliferation of cells in the lymphatic tissue of lymph nodes and spleen)
- a malignant melanoma (malignant skin tumor originating from melanocytes = black cells)
- a Merkel cell tumor (highly malignant, rare small cell neoplasm that spreads quickly)
- a squamous cell carcinoma (form of skin cancer)
- a sebaceous gland carcinoma
- metastases (spreads) from another tumor
Treatment by surgery
Basal cell carcinoma is almost always a locally invasive disease. Treatment is necessary to prevent damage to surrounding tissues. This is done through a complex operation. The surgeon completely removes a basal cell carcinoma, taking a wide margin so that the tumor is certainly gone. Occasionally radiotherapy and/or chemotherapy is also necessary. When the tumor is relatively small, treatment with topical cream (applied to the eyelid) is also successful.
Complications
The tumor occasionally returns. In rare cases, the tumor spreads to other parts of the body. Left untreated, these tumors also grow around the eye and in the eye socket, sinuses and brain.
Prognosis
The five-year survival is very high, namely 98%. The prognosis is worse in patients with:
- Deeply invasive tumors
- Inadequate treatment
- Long-term injuries
- Lesions larger than 3 cm
Prevention of malignant tumor
Preventing basal cell carcinoma is possible by minimizing exposure to sunlight. A patient does this by using sunscreen products, as well as wearing a cap, wide-brimmed hat and appropriate clothing.
read more
- Eye tumors: Retinoblastoma, melanoma, lymphoma of the eyes
- Skin cancer: Malignant skin growths and skin tumors
- Basal cell carcinoma: Slow-growing form of skin cancer
- Periocular skin cancer: Types of cancer around the eye
- Eyelid cancer: Types and treatment of eyelid cancer