Eyelid Lesion as a Presenting Sign of Pancreatic Adenocarcinoma

Eyelid metastases are relatively rare, and they can occasionally lead the way to an unknown primary malignancy elsewhere. The authors report a case of 65-year-old diabetic gentleman with a right-sided eyelid lesion that was present for 1 month and turned out to be a presenting sign of a previously undiagnosed pancreatic adenocarcinoma. The eyelid mass had been treated elsewhere for 2 weeks for a presumed infectious lesion, using systemic antibiotics and was then referred to us in view of no response. The right-sided lesion involving the subbrow and eyelid area was tender and showed surface ulceration, as well as induration with scabbing. An incision biopsy of the mass was performed followed by computed tomography imaging. Histopathologic findings were suggestive of adenocarcinoma of a probable secondary origin. A whole-body positron emission tomography (PET) scan along with raised serum tumor markers (carcinoembryonic antigen 125 [CEA 125] and carbohydrate antigen 19-9 [CA-19-9]) was helpful in diagnosing a stage IV probable primary carcinoma of the pancreas, with metastasis to paraaortic nodes, liver, lungs, and eyelid. After a detailed systemic work-up, the patient was put on systemic chemotherapy with carboplatin and capacitabane. He responded well to the treatment. At a follow up of 12 months, upon clinical examination and PET imaging, he showed a complete resolution of eyelid, lung, and liver disease and a near-complete resolution of the pancreatic lesion. This case delineates the role of a prompt biopsy and histopathologic evaluation of an atypical eyelid mass in diagnosing asymptomatic primary malignancy.