Periocular malignancies and primary eye care

In 1985, an estimated 92,000 new cases of skin malignancies were diagnosed worldwide. Based on reports from the United States Environmental Protection Agency, as the stratospheric ozone layer continues to be depleted, the number of new cases of skin cancer are predicted to climb by as many as 12 million over the next 50 years. Up to 90% of all cases of skin cancer occur in the vicinity of the head or neck and 10% of those involve the eyelids.

We surveyed the literature regarding the incidence, diagnosis, differential diagnosis, management, prognosis, and prevention of the most common periocular malignancies. The types of malignancies include basal cell carcinoma, squamous cell carcinoma, sebaceous cell carcinoma, and malignant melanoma.

The period of greatest risk for the development of skin cancer begins in the fourth decade and increases with advancing age. Up to 20% of periocular skin lesions are malignant. Perhaps the most-significant risk factor is innate skin coloration. Workup for these entities includes biopsy as the first step in diagnosis and management of skin cancers. Punch, incisional, or excisional biopsy may be performed, depending on the size and location of the lesion. Treatment alternatives, used when surgical intervention is unable to be tolerated, include radiation therapy, cryotherapy, chemotherapy, interferons, and recently developed photodynamic therapy.

The importance of gross observation, examination, and careful slit-lamp biomicroscopy of the ocular adnexa cannot be overstated as a means of detection, diagnosis, and management of beginning, impending, or worsening malignancies.