Eyelid tumors can be both benign and malignant. The management of these pathologies varies according to the type of the lesions. Previously, the most widely accepted treatment option was surgical excision of the lesion. However, with time, as the knowledge in understanding of these diseases has increased, so have the treatment options. Multiple new avenues have opened other than surgery. In this article, the authors discuss the recent advances in the medical management of eyelid tumors.
Key points
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Medical management is being increasingly used to manage tumors of the eyelid.
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Beta-blockers have been found effective in the treatment of vascular lesions in the periocular area. Periocular Venolymphatic malformations are currently managed using sclerotherapy.
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Sebaceous gland carcinoma tumors express programmed cell death protein 1 (PD 1) and programmed cell death-ligand 1 (PD-L1) receptors making them viable for immunotherapy.
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Basal cell carcinoma (BCC) is associated with hedgehog pathway gene mutations. Vismodegib and sonidegib can be used in the immunotherapy of BCC.
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Squamous cell carcinoma (SCC) overexpresses epidermal growth factor receptors (EGFRs). Studies have shown cetuximab, gefitinib, panitumumab, and erlotinib, which are EGFR inhibitors, can be used in the management of SCC.
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Malignant melanoma is associated with BRAF gene mutations. Vemurafenib, dabrafenib, and encorafenib BRAF inhibitor thus can be used in immunotherapy of malignant melanomas.
Introduction
The eyelids commonly are exposed to sunlight. This frequent and chronic sun exposure is the reason why nearly 5% to 15% of all skin malignancies are associated with this region [ ]. However, not all eyelid tumors are cancerous; in fact, nearly 82% to 98% of all eyelid lesions are benign [ ].
In the nineteenth and the twentieth centuries, the main treatment option was surgical excision of the lesion. However, in the last few decades, the management of these lesions has evolved significantly. With advances in various imaging and other diagnostic modalities, the staging of the lesions has improved. The malignant lesions are classified as per the American Joint Committee on Cancer system, and the treatment is planned accordingly. If the lesions are superficial and small, surgical excision with reconstruction of the eyelid still serves the purpose quite well. However, in cases of deeper tissue involvement, surgery can be quite extensive and debilitating for the patient.
Certain nonsurgical options have come up in the recent past, while few are still in the experimental phase.
Advances in benign eyelid tumors
Beta-blockers in vascular eyelid lesions
Benign vascular tumors are frequent in children. Capillary hemangioma is the most common of them. In the last decade, multiple studies have concluded that beta-blockers are effective in the management of these lesions [ , ] ( Fig. 1 ). The Food and Drug Administration (FDA) has already approved the systemic use of oral propranolol in the management of eyelid and orbital infantile capillary hemangioma [ ] Table 1 illustrates the indications and dose of propranolol. The use of oral propranolol has been associated with multiple side effects, and a multi-systemic evaluation must be conducted before the initiation of this therapy. In recent times, topical application of beta-blockers is gaining popularity [ ]. Topical application comes with fewer systemic adverse reactions.
| Indication | Dose | Side effects |
|---|---|---|
| 1.7 mg/kg |
|
Pyogenic granulomas are extremely common lesions noted in the eyelids and periocular area. They usually occur in the eyelids following some trauma, chalazion, or surgery. They also cause a significant number of cosmetic blemishes. Previously, the management options involved the application of steroids, removal of inciting foreign bodies, surgical excision, and cautery of the lesion. In the present-day scenario, multiple studies have revealed the beneficial use of topical beta-blockers, namely timolol 0.5% in ointment formulation in eyelid pyogenic granulomas [ ] ( Fig. 2 ).
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