Ocular Tumours: Eyelid, Conjunctiva, Uvea and Orbit
Last updated: October 2026
Ocular oncology is a small specialty, but every ophthalmologist must recognise the tumours that threaten sight or life. This page covers the most important tumours of the eyelid, conjunctiva, eye and orbit, with the clinical clues that should make you refer.
Eyelid tumours
| Tumour | Key features | Management notes |
|---|---|---|
| Basal cell carcinoma | Most common malignant eyelid tumour. Lower lid and medial canthus; pearly nodule with telangiectasia, ulcer ("rodent ulcer"), loss of lashes | Excision with margin control (e.g., Mohs or frozen sections). Medial canthal tumours can invade the orbit. |
| Squamous cell carcinoma | Keratinised, scaly or ulcerated lesion; can spread to lymph nodes and along nerves | Wide excision with margin control; check regional nodes |
| Sebaceous gland carcinoma | Masquerades as a recurrent chalazion or chronic unilateral blepharoconjunctivitis; more common in Asian patients and on the upper lid | Biopsy any recurrent chalazion in an older patient. Needs wide excision and conjunctival map biopsies. |
| Melanoma | Rare; pigmented, changing lesion | Excision with margins; specialist referral |
Conjunctival tumours
- Ocular surface squamous neoplasia (OSSN): a gelatinous, leukoplakic or papillary lesion at the interpalpebral limbus, often with feeder vessels. Risk factors include UV exposure and HIV infection, so consider HIV testing in young patients.
- Treatment: "no-touch" excision with clear margins and cryotherapy, or topical chemotherapy (interferon alpha-2b, 5-fluorouracil or mitomycin C).
- Conjunctival melanoma: often arises from primary acquired melanosis (PAM) with atypia. Suspect it with nodularity, thickening, feeder vessels or growth.
- Conjunctival lymphoma: a salmon-pink patch, often in the fornix. Biopsy and systemic staging.
Uveal melanoma
- The most common primary intraocular malignancy in adults.
- Naevus or melanoma? Remember the Shields mnemonic "To Find Small Ocular Melanoma Using Helpful Hints Daily": Thickness >2 mm, Fluid (subretinal), Symptoms, Orange pigment, Margin within 3 mm of the disc, Ultrasound hollowness, Halo absent, Drusen absent. More risk factors mean a higher chance of growth.
- Ultrasound: low-to-moderate internal reflectivity, choroidal excavation, and a mushroom (collar-stud) shape when the tumour breaks through Bruch's membrane.
- Treatment: plaque brachytherapy, proton beam therapy, or enucleation for large tumours. See COMS findings.
- The liver is the main site of metastasis; patients need long-term systemic surveillance with an oncologist.
Other intraocular tumours
- Choroidal metastasis: the most common intraocular malignancy overall. Usually from breast cancer in women and lung cancer in men; often a creamy-yellow, plaque-like lesion, sometimes multiple or bilateral.
- Retinoblastoma: the most common primary intraocular malignancy of childhood. Presents with leukocoria or strabismus; calcification on imaging. See retinoblastoma genetics and leukocoria.
- Circumscribed choroidal haemangioma: orange-red, dome-shaped lesion at the posterior pole; high internal reflectivity on ultrasound. The diffuse form ("tomato ketchup fundus") occurs in Sturge-Weber syndrome.
- Vitreoretinal lymphoma: an older patient with vitritis that does not respond to steroids. See masquerade syndromes.
Orbital tumours
| Age group | Common lesions | Clues |
|---|---|---|
| Children | Dermoid cyst; infantile (capillary) haemangioma; rhabdomyosarcoma | Rhabdomyosarcoma is the most common primary orbital malignancy in children: rapidly progressive proptosis over weeks needs urgent biopsy. Infantile haemangiomas often respond to propranolol. |
| Adults | Cavernous venous malformation (cavernous haemangioma); lymphoma; lacrimal gland tumours; metastases | Cavernous venous malformation is the most common benign orbital mass in adults: slowly progressive, painless axial proptosis. |
The most common cause of proptosis in adults is not a tumour but thyroid eye disease.
When to refer to an ocular oncologist
- Any pigmented choroidal lesion with several risk factors for melanoma, or documented growth
- Leukocoria in a child: same-day or next-day referral
- Recurrent "chalazion" or chronic unilateral blepharitis in an older adult
- Rapidly progressive proptosis, especially in a child
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