Contemporary Management of Malignant Eyelid Tumours: Surgical and Immunotherapeutic Advances

This review provides an updated overview of the contemporary management of malignant eyelid tumours, focusing on evidence-based advances in both surgical and immunotherapeutic approaches. Eyelid malignancies represent a significant health burden, particularly in Australia and New Zealand where skin cancer rates are the highest globally. The article details the epidemiology, clinical presentation, diagnosis, and risk stratification for the five most common eyelid cancers: basal cell carcinoma, squamous cell carcinoma, sebaceous gland carcinoma, melanoma, and Merkel cell carcinoma. Current best practises emphasise microscopically controlled surgical excision as the mainstay of curative therapy, with excision margins tailored according to tumour and histology type. Mohs micrographic surgery and peripheral and deep margin assessment techniques are highlighted for improved local control and eyelid preservation. The review discusses the expanding role of immuno- and targeted therapies such as checkpoint inhibitors including program cell death (PD-1) and programmed cell death ligand (PD-L1) inhibitors, as well as targeted hedgehog inhibitors for unresectable and metastatic disease in melanoma, Merkel cell carcinoma, and advanced squamous cell carcinoma, demonstrating enhanced progression-free survival and durable responses. Management algorithms are increasingly multidisciplinary, integrating ophthalmology, dermatology, oncology, pathology, and reconstructive surgery. Ongoing challenges include timely detection, management of adverse effects, and the risk of recurrence and metastasis, necessitating long-term surveillance and individualised care.