Eyelid cancer is uncommon but not as rare as you might expect. Despite making up a tiny fraction of your body’s skin surface, the eyelids account for 5% to 10% of all skin cancers. The overall incidence rate in the United States hovers around 0.1 per 100,000 people, and that number has been gradually climbing over recent decades. So while your individual risk is low, eyelid cancer is far from unheard of in dermatology and ophthalmology clinics.
How Common Is Each Type
The vast majority of eyelid cancers are basal cell carcinoma, making up roughly 85% to 95% of all malignant eyelid tumors. One large clinical review found basal cell carcinoma in 90.9% of cases. This is the same slow-growing skin cancer that commonly appears on the nose, ears, and other sun-exposed areas. On the eyelid, it tends to show up as a small, painless bump or sore that doesn’t heal, often on the lower lid near the inner corner of the eye.
Squamous cell carcinoma is the next most common, accounting for roughly 5% to 10% of eyelid malignancies. After that, the numbers drop sharply. Sebaceous gland carcinoma, which arises from the oil glands in the eyelid, represents 1% to 3% of eyelid cancers in Western countries. Eyelid melanoma is rarer still, making up about 1% of eyelid malignancies and less than 1% of all skin melanomas, with an estimated incidence of 0.05 to 0.1 cases per 100,000 people per year. Merkel cell carcinoma of the eyelid is the rarest of the major subtypes, with an incidence of roughly 0.2 to 0.3 per 100,000.
Geography Changes the Picture
Those percentages shift dramatically depending on where you live. Sebaceous gland carcinoma, considered rare in the West at 1% to 3% of cases, is far more prevalent in parts of Asia. Studies from Japan have found it in 54% of eyelid tumors, and Indian research reports rates of 43% to 56%. Researchers in Taiwan have documented it at 8%, and the Philippines at 30%. The reasons aren’t fully understood, but the pattern is consistent enough that the Western characterization of sebaceous carcinoma as “rare” doesn’t hold globally.
Who Gets Eyelid Cancer
The average age at diagnosis is about 67, and risk rises steeply with age. Compared to people under 20, those between 40 and 65 are about 24 times more likely to develop eyelid cancer. People over 65 face roughly 43 times the risk. Men are about 40% more likely to be diagnosed than women.
Race and ethnicity also matter. White, non-Hispanic individuals have the highest rates. African Americans have about 88% lower odds, and Asian Americans about 81% lower odds compared to white patients. Hispanic individuals have roughly 62% lower odds than non-Hispanic individuals. Active smoking is another associated risk factor. The profile of a high-risk patient, statistically speaking, is an older white, non-Hispanic man who smokes.
Sun exposure is the primary driver. The eyelids sit in one of the most sun-exposed areas of the face, and many people skip sunscreen on and around their eyelids or don’t wear sunglasses consistently. Decades of cumulative UV damage explain why eyelid cancer overwhelmingly appears later in life.
Where on the Eyelid Tumors Appear
Tumors occur on the upper and lower eyelids at nearly equal rates. In one clinical study of 75 patients, 46.7% had tumors on the upper lid and 42.7% on the lower lid, with the remaining 10.7% at the inner or outer corners of the eye. For basal cell carcinoma specifically, the lower eyelid and inner corner are the most common locations, likely because these areas catch more reflected UV light.
How It Gets Mistaken for a Stye
One of the more concerning aspects of eyelid cancer is that it can look like a harmless bump. A study examining over 1,000 lesions clinically diagnosed as chalazia (the plural of chalazion, a blocked oil gland that causes a painless eyelid lump) found that 6.4% were misdiagnosed. Among those, 1.4% turned out to be malignant. Sebaceous gland carcinoma was the most commonly missed cancer, accounting for 12 of those cases, followed by basal cell carcinoma at three cases.
This matters because sebaceous gland carcinoma is particularly dangerous when caught late. Unlike basal cell carcinoma, which grows slowly and rarely spreads, sebaceous carcinoma can metastasize. A chalazion that keeps coming back in the same spot, doesn’t respond to treatment, or causes eyelash loss warrants a biopsy rather than repeated rounds of warm compresses.
Survival Rates by Type
The prognosis for most eyelid cancers is good when caught early. Basal cell carcinoma, which dominates the statistics, almost never spreads to other parts of the body and is highly curable with surgical removal. Recurrence rates for eyelid basal cell carcinoma sit around 11% in clinical studies.
Squamous cell carcinoma is more aggressive, with one study documenting recurrence in 57% of eyelid cases, though this varies widely based on how advanced the tumor is at the time of surgery. Eyelid melanoma carries a five-year overall survival rate of about 70.5%, though this depends heavily on the subtype. Superficial spreading melanoma has a five-year survival of 82.1%, while nodular melanoma, the more aggressive form, drops to 56.5%. The disease-specific survival rate (meaning deaths caused by the melanoma itself rather than other causes) is higher at 90.6%, reflecting that many patients with eyelid melanoma are elderly and may die of unrelated conditions.
Sebaceous gland carcinoma recurs in about 14% of cases, but its tendency to be misdiagnosed means it’s often caught at a more advanced stage. Melanoma of the eyelid has the highest recurrence rate at 60% in some series, with recurrences appearing in an average of just 22 months.
Trends Over Time
Eyelid cancer has been getting more common. The incidence of eyelid melanoma roughly doubled between 1975 and 2016, rising from 0.04 to 0.10 per 100,000 people, with the steepest increases in people over 70. Sebaceous carcinoma incidence rose significantly through 2016, reaching about 2.4 per million, with the highest rates in elderly non-Hispanic white men. Merkel cell carcinoma of the eyelid has increased roughly 95% between 2000 and 2013.
Whether these increases reflect a true rise in cancer rates or better detection and reporting is debated, but the trend is consistent across subtypes. An aging population with decades of cumulative sun exposure is the most likely explanation for at least part of the increase.