Metastatic breast cancer to 4 eyelids: a clinicopathologic report

A 47-year-old woman presented complaining of progressive, painless swelling of all 4 eyelids for 6 weeks. Her medical history was significant for breast cancer 14 months prior. Examination results showed a diffuse, firm thickening of all 4 eyelids with mild erythema of the overlying skin. Orbital computer tomography revealed extensive preseptal infiltration of soft tissue of all 4 eyelids, which enhanced with contrast. Results of a bilateral biopsy of the upper eyelids demonstrated extensive infiltration of the orbicularis muscle. Histologic features were consistent with metastatic breast cancer. Results of both the primary breast cancer biopsy taken 14 months previously and the eyelid biopsies were the same histologic type. Presentation of metastatic breast cancer to the eyelids is rare, but a recurrence must be considered in any patient with a history of breast cancer, despite the length of tumor-free survival. Bilateral involvement should not exclude metastases from diagnostic consideration, but rather, the diagnosis requires a high degree of clinical suspicion and recognition of the various cutaneous forms.