Metastatic tumors to the eyelid: report of 20 cases and review of the literature.

OBJECTIVE To determine the primary sites, clinical features, treatment, and outcome of 20 patients with cancer metastatic to the eyelids. METHODS Retrospective review of medical records. RESULTS The primary tumors included skin melanoma (4 [20%]), uveal melanoma (4 [20%]), breast carcinoma and conjunctival melanoma (3 [15%] each), renal cell carcinoma (2 [10%]), and medullary thyroid carcinoma, prostate carcinoma, lung carcinoma, and salivary gland carcinoma (1 [5%] each). Eyelid metastasis was the first sign of systemic cancer in 3 patients (15%). The most common clinical finding at the initial examination was a solitary nodule in 12 patients (60%), a flat pigmented lesion and diffuse eyelid swelling in 3 patients each (15%), and multiple nodules and epiphora in 1 patient (5%) each. Ten patients (50%) had concomitant ocular site metastasis. Primary treatment included excision alone in 6 patients (30%), external beam radiotherapy in 7 (35%), systemic chemotherapy in 4 (20%), and observation in 3 (15%). The metastatic tumors regressed in 10 patients (50%), remained stable in 7 (35%), and showed progression in 3 (15%). After a mean follow-up of 16 months, 9 patients (45%) were alive and 11 (55%) had died of systemic metastatic disease. CONCLUSIONS Eyelid metastasis can display a variety of clinical features and should be considered in patients with known systemic cancer. These patients usually have multiple metastatic sites, ocular and nonocular. The systemic prognosis is poor.