Principles of management for malignant eyelid tumours

The management of all malignant eyelid tumours depends on:

• Correct histological diagnosis

• Assessment of tumour margins

• Assessment of systemic tumour spread

Figure 6.9 Red Merkel cell tumour.

Focal malignancy can be treated with:

The choice of therapy depends on:

• The location of the tumour

• The age and general health of the patient

• The clinician's relative expertise.

The choice of treatment is particularly important in:

• Diffuse tumours

• Tumour extension to bone/the orbit

• Patients with a cancer diathesis for example, the basal cell nevus syndrome.

A comprehensive examination of the patient is important with palpation of the regional lymph nodes and a whole body skin examination wherever possible. If orbital invasion is suspected from clinical examination, for example restriction of ocular motility, it is appropriate to request thin section, high resolution CT scans with bone windows. In selected cases chest and abdominal CT is required plus liver function tests to evaluate systemic spread. If systemic spread is found, palliation only may be preferable.

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