Basal Cell Carcinoma on the Eyelid: Symptoms and Treatments

Your eyelids have some of the thinnest skin on your body, and any skin condition that affects your eyelids may also affect your eye health, too. About 20 percent of basal cell carcinomas (BCCs) that occur on the head and neck region happen on the eyelid. In fact, BCC makes up about 90 percent of all eyelid cancers.

Here we’ll discuss how BCC on the eyelid may appear, what to expect from treatment, and important facts about your outlook.

What Is Basal Cell Carcinoma?

Basal cell carcinoma is a very common type of skin cancer. It starts in basal cells, which are small, round cells in the lower part of the epidermis (the top layer of skin). BCC is often linked to damage from ultraviolet (UV) light from the sun or tanning beds.

Eighty percent of all BCCs show up somewhere on the head or the neck, which can include the eyelid.

Most BCCs that develop on the eyelid first show up on the lower lid.

BCC usually grows slowly. Many people get it diagnosed and treated before it grows deeper into nearby tissue or metastasizes (spreads to other parts of the body), which is rare.

How Is BCC on the Eyelid Treated?

Most of the time, BCC on the eyelid is treated by removing the skin cancer via surgery. Some people may also need reconstructive surgery to help restore the eyelid’s appearance and function after the cancer is removed.

If you decide to undergo surgery, your skin cancer specialist will recommend a technique that best fits your situation. The type of surgery depends on factors such as the tumor’s stage, size, location, depth, and subtype.

One common surgery is Mohs micrographic surgery. During this procedure, a dermatologist removes thin layers of skin and examines each layer under a microscope. The process continues until no cancer cells remain.

Most BCC tumors on the eyelid are treated with surgery. You may also need reconstruction of your eyelid after cancer has been removed.

Mohs surgery is often considered when it is important to preserve as much healthy tissue as possible.

Other surgical options for BCC include:

• Standard surgical excision — Removal of the tumor along with a margin of healthy tissue
• Electrodesiccation and curettage — Scraping away the tumor and using heat to destroy remaining cancer cells
• Cryosurgery — Freezing the tumor to destroy cancer cells

These approaches are used less commonly when BCC is on the eyelid. Your doctor can explain why they recommend one technique over another.

Alternatives to Surgery

If surgery isn’t a good treatment option for you, your healthcare provider may recommend other treatments, such as radiation therapy or topical medications.

If you have advanced basal cell carcinoma, your skin cancer specialist may recommend systemic (whole-body) treatments, such as targeted therapy or, in some cases, immunotherapy. Immunotherapy helps the immune system recognize and attack cancer cells.

What To Expect if You Need Surgery for BCC on the Eyelid

Some details about surgery for BCC on the eyelid will depend on what type of surgery you have. In general, you should expect that your care team will use a local anesthetic (medicine that numbs the area) or, for more extensive surgery, general anesthesia (medicine that puts you to sleep).

You may be awake and receive an injection to numb your eyelid. Once it’s numb, you may still feel pulling or pressure, but you shouldn’t feel pain during the procedure.

When you’re numb, the dermatologist will remove the basal cell carcinoma. If you’re having Mohs surgery, your doctor will remove a thin layer of tissue, examine it under a microscope, and repeat the process if cancer cells remain. You’ll wait while this happens because they may need to remove more layers.

Once the cancer is gone, your doctor may close the wound with stitches and put a dressing over the area. Follow your care team’s instructions about how long to keep the dressing in place and when to change it.

Depending on the size and location of the wound, sometimes the doctor will allow it to heal over time without closing it with stitches.

What To Expect for Reconstructive Eyelid Surgery

Reconstructive surgery for the eyelid usually happens the same day as the removal of the skin cancer, but it may take place later — typically one to seven days — depending on your care plan.

If a large part of your eyelid is removed, reconstruction may involve a skin graft. A skin graft is a piece of healthy skin moved from another part of your body to cover and repair the area where the cancer was removed.

If the reconstructive surgery is taking place in a surgical center or operating room, it may involve general anesthesia, which means you likely won’t be awake during the surgery. Afterward, you’ll need a dressing, and you won’t be able to drive.

Your doctor will tell you how to manage pain following surgery. They may prescribe pain medication or recommend an over-the-counter option, along with instructions for how often to take it.

Your doctor may prescribe an antibiotic to help prevent infection. They may also recommend an antibiotic ointment to use on the area as it heals. Follow your care team’s instructions exactly.

Risks of Eyelid Surgery for BCC

Most people who undergo surgery for BCC on the eyelid don’t have lasting disfigurement. However, after surgery to remove a BCC tumor or reconstruct the eyelid, some people experience:

• Bruising
• Swelling
• Scarring
• Loss of eyelashes, which may be temporary or permanent
• A noticeable difference in appearance or position between the affected eyelid and the other eyelid

Your cancer care team can explain ways to care for the area as it heals and help minimize visible scarring when possible.

What’s the Prognosis for BCC on the Eyelid?

Most people who find basal cell carcinoma early and get it treated promptly have a good prognosis (outlook). BCC usually grows slowly, and it rarely metastasizes. However, if BCC is not treated, it can grow deeper into nearby tissue and cause damage.

Eyelid BCC tumors don’t often recur (come back), but your risk for developing a BCC in other areas of skin will be higher in years to come.

Eyelid BCC tumors can recur (come back) after treatment, but this doesn’t happen for everyone. After having one BCC, your risk of developing another BCC or other skin cancer is higher.

For these reasons, your doctor will want to monitor your skin closely for a period of time — generally for several years. How long you’ll need follow-up care may depend on the stage of your basal cell carcinoma and any additional risk factors you have for recurrence.

When Should You Talk to Your Doctor?

If you notice any changes to your eyelids, talk to a healthcare provider right away. If you have a new bump or a sore that doesn’t seem to heal, your doctor can refer you to a specialist who can test your skin for cancer and recommend the treatment you need.

If you’ve already been treated for BCC, talk to your doctor if you notice any skin changes between follow-up appointments. Don’t wait for your next scheduled appointment if you think BCC may have returned.

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On MySkinCancerTeam, people share their experiences with nonmelanoma skin cancer, get advice, and find support from others who understand.

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