Eyelid tumors are divided into two main categories: benign and malignant. Benign tumors are more common and can be solid or cystic, solitary or multiple, and increase with age. Clinically, most benign eyelid tumors are easily diagnosed and most are surgically removed for cosmetic reasons. However, the diagnosis of malignant tumors is often more difficult to confirm. In addition to age, medical history, tumor morphology, growth rate, bleeding tendency, and lymph node metastasis, the eyelid is located on the surface of the body, so the tumor can be easily removed for pathologic examination to confirm the diagnosis. In addition to the prognosis of the tumor, treatment should also take into account the functional and cosmetic protection of the eyelid. Benign tumors (a) Hemangioma of the lid is a congenital abnormality in the development of vascular tissue. Capillary hemangioma is the most common type of eyelid hemangioma and consists of proliferating capillaries and endothelial cells. They occur at birth or shortly after birth and grow rapidly, often regressing on their own by age 7. If the area is superficial, it is bright red, hence the name “strawberry nevus”; if the area is deeper, it is blue or purple. There are usually no irritating symptoms. Deeper hemangiomas may involve the eye orbit, causing it to enlarge. The affected eye may develop astigmatism due to the pressure of the hemangioma, resulting in refractive error, strabismus, or amblyopia. Capillary hemangiomas should be distinguished from the less common “nevus flammeus” (flame nevus). A nevus flammeus, also known as a port wine stain, is purple in color and consists of dilated sinusoidal vessels. It is present at birth, does not grow and regress as significantly as capillary hemangioma, and is often associated with Sturge-Weber syndrome. If for cosmetic reasons, laser surgery may be considered for removal. Glucocorticoid injections are not effective. Treatment: ①Because capillary hemangioma tends to regress on its own, it can be observed for a period of time and usually treated after 5 years of age. However, if the tumor causes the eyelid to fail to open and block the pupil, you cannot wait to avoid amblyopia. The preferred treatment is to inject long-acting glucocorticoids into the hemangioma. Care should be taken not to inject the drug into the systemic blood circulation during treatment. If treatment is ineffective, it may be replaced with cryosurgery or partial surgical excision. Spongiform hemangioma, also a common eyelid hemangioma, is the most common benign tumor of the adult orbit. It consists of a large vascular lumen lined by endothelial cells and lined with smooth muscle. This hemangioma is developmental rather than congenital and often occurs before the age of 10 years. It does not regress on its own, but increases in size. (b) Pigmented nevus (nevus) is a congenital flattened or elevated lesion of the eyelid with well-defined boundaries and composed of nevus cells. They may be pigmented at an early age or not until adolescence or adulthood. Histologically, they can be divided into: ① Junctional nevi, which are usually flat and uniformly brown in color, with nevus cells located at the junction of the epidermis and dermis. They appear clinically as flat, pigmented rashes, round or oval, with slow growth and a low tendency to malignant transformation. (ii) Intradermal nevi, the most common, are usually elevated and sometimes papilloma-like. There is little pigmentation, or brown to black if present. The nevus cells are completely within the dermis and may have no malignant tendency. (iii) Complex nevus, often brown in color, consists of the first two types of components combined together. It has a low malignant tendency. (iv) Blue nevus, usually flat, almost pigmented at birth, is blue or slate gray. No malignant tendency. ⑤ Congenital oculocutaneous melanocytosis, also known as nevus of Ota, is a blue nevus surrounding the skin of the orbit, eyelids and eyebrows. It occurs in oriental and black people and has no malignant tendency. If it occurs in whites, it has a malignant tendency. The increased incidence of choroidal melanoma is related to this. Treatment】 ①If there is no sign of malignant change such as rapid enlargement and blackening and bleeding, treatment is not necessary. If the nevus needs to be removed for cosmetic purposes, it must be complete and thorough, otherwise the residual nevus cells may be stimulated by surgery and become malignant. (C) Macular tumor (xanthelasma) is common in middle-aged and elderly people. It can occur in patients with hereditary hyperlipidemia, diabetes mellitus, and other secondary hyperlipidemia, but most patients have normal lipids. The lesions are located on the upper lid near the medial canthus and sometimes on the lower lid, often bilaterally, and appear as soft, flat, yellow spots that are slightly elevated and clearly demarcated from the surrounding normal skin. Macular tumors are not actually tumors, but rather deposits of lipid-like material in the skin tissue. It is not necessary to treat it unless it can be removed surgically for cosmetic purposes. After removal, there is a possibility of recurrence. Malignant tumors (a) Basal cell carcinoma is the most common malignant tumor of the eyelid in China, mostly in the middle-aged and elderly. It accounts for about 90% of eyelid malignancies and 29% of eyelid tumors. Photochemical damage is the most important pathogenic factor in the development of basal cell carcinoma and most other epidermal tumors. Histologically, basal cell carcinomas are composed of small, regularly shaped, firm lobules with basophilic cells and a lack of cytoplasm. It is prevalent in the lower lid near the medial canthus. Initially, they are small nodules with dilated capillaries visible on the surface. It can be mistaken for a pigmented nevus or melanoma because it is pigment-rich, but it is elevated, firm, and slow-growing. Patients do not feel pain. The central part of the tumor develops ulcers with submerged edges, shaped like a crater, and gradually erodes into the surrounding tissues, causing extensive destruction. It rarely metastasizes, and if it does, it most often metastasizes to the lungs, bones, lymph nodes, liver, spleen and adrenal glands. The average survival time after metastasis has been reported to be 1.6 years. Treatment】This tumor is sensitive to radiation therapy, so it should be resected early and then treated with radiation therapy. Since the cancer cells usually infiltrate in all directions, beyond the normal margin shown clinically, the scope of surgical resection should be large enough, and it is better to apply frozen section to examine the margin of the resected specimen. (2) Squamous cell carcinoma is a kind of malignant neoplasm of epidermal keratinized cells. It occurs mostly in middle-aged and elderly people, preferably in the mucosal migration of the skin at the lid margin. It grows slowly and is not painful to the patient. It begins like a papilloma and gradually forms an ulcer with slightly elevated, hard edges that can become necrotic and secondary to infection. It not only erodes peripherally and deeply, but also invades subcutaneous tissues, lid, eye, orbit and intracranium, and can metastasize to distant lymph nodes via the lymphatic system. Treatment】Surgery is the mainstay. According to the size of the tumor, the scope of eyelid resection should be determined, and then radiation therapy should be performed. (c) Sebaceous gland carcinoma is one of the common malignant tumors of the eyelid in China. Environmental factors that cause carcinoma act extensively on the glandular cells of the eyelid gland are the possible causes. It occurs most frequently in middle-aged and older women, preferably in the upper lid. It most commonly originates in the sebaceous glands of the lid and eyelashes. If it originates from the lid gland, it begins as a small subcutaneous nodule on the eyelid, similar to a lid cyst. It gradually increases in size, with diffuse patchy thickening of the lid. The corresponding lid conjunctiva is yellowish and elevated. If it arises from the sebaceous glands, it appears as a small yellow nodule at the lid margin. The surface skin is normal. As the mass gradually increases in size, it may form an ulcer or take on a cauliflower shape. It may extend into the orbit, invade the lymphatic vessels, and metastasize. 【Treatment】The disease is highly malignant. It is not sensitive to radiotherapy. The prognosis is better after surgical excision when it is limited in the early stage. In late stage, it has invaded adjacent tissues and is prone to recurrence after surgery. Since sebaceous gland carcinoma is very similar to lid cyst, pathological examination should be performed on lid cysts in the elderly, and those who recur after excision should be more alert.