Review finds eyelid tumors that spread often resembled harmless growths
The analysis combined 73 published reports and found that breast cancer was the most common original cancer in these cases.
Moderate evidenceReviewInterpret with caution
Medical disclaimer: This article summarizes research findings and is for informational purposes only. It is not medical advice.
Editorial illustration — not from the study.
A systematic review examined published reports of cancer that had spread to the eyelid. Across 73 studies involving 95 people, breast cancer was the most commonly reported original cancer, and eyelid metastases often appeared similar to benign growths before biopsy.
The review also found that eyelid biopsy sometimes helped identify an otherwise hidden original cancer or changed cancer care. Because the evidence came from case reports and case series, the results show patterns among reported cases rather than rates or outcomes for people with eyelid lesions in general.
What the review covered
Researchers conducted a PRISMA 2020-compliant systematic review of PubMed/MEDLINE, Embase, Scopus, and additional citation sources. They included case reports and case series published through a search performed on March 7, 2026, when the eyelid metastasis had been confirmed by tissue examination. The review synthesized clinical features, original cancer sites, pathology and immunohistochemistry findings, diagnostic errors, distant spread, and effects on cancer management. Risk of bias was assessed with the Joanna Briggs Institute checklist for case reports.
What the evidence shows
Among the 95 patients, 39 (41.1%) had breast cancer as the original cancer, followed by gastrointestinal tumors in 15 (15.8%), kidney cancer in 9 (9.5%), and lung cancer in 8 (8.4%). Of 92 patients with information about timing, 58 (63.0%) had eyelid involvement after the original cancer had already been diagnosed, 27 (29.3%) had it at the same time, and 7 (7.6%) had it as an occult presentation. The median interval for later presentation was 36 months, with a range of 2 to 288 months.
Among 62 patients whose preoperative impression was documented, 41 (66.1%) were initially thought to have a benign condition; a pyogenic granuloma was the most common mistaken appearance. Immunohistochemistry was reported in 61 of the 73 studies. BAP1 loss was reported in 2 of 3 evaluable uveal melanoma cases and was intact in all 6 cutaneous melanoma cases, but these numbers are very small. At the time of eyelid biopsy, 61 of 89 patients (68.5%) had distant metastases elsewhere. The eyelid biopsy identified an occult original cancer in 11 of 95 patients (11.6%) and was reported to change cancer management in 13 (13.7%). These are descriptive findings from published cases and do not establish that any specific test or biopsy approach causes better outcomes.
Who this is relevant to
These findings describe 95 people with tissue-confirmed cancer that had spread to the eyelid, based on published case reports and case series. They may be most relevant to clinicians and researchers evaluating unusual eyelid lesions in people with known or possible cancer, but they do not describe the likelihood that an eyelid lesion in the general population is metastatic.
What this could mean
The review highlights that, in the published cases, metastatic eyelid tumors could resemble common benign eyelid growths. It also shows that tissue examination and laboratory staining were used to clarify the diagnosis and sometimes revealed a previously unknown original cancer. These observations may help inform medical understanding of a rare presentation, but the review cannot determine how often such appearances occur, how accurately clinicians can distinguish them before biopsy, or whether any particular diagnostic strategy improves patient outcomes. The findings are from humans; no animal or laboratory-only findings were included.
Limitations & evidence assessment
The review included only 95 patients from 73 case reports and case series, so the findings may be affected by selective publication of unusual or severe cases. There was no control group, and the review was descriptive rather than a test of diagnostic accuracy or treatment effects. Some information was missing: for example, presentation timing was reported for 92 patients, and findings about distant metastases were available for 89. The abstract does not provide the individual risk-of-bias results, follow-up details, or enough information to determine how representative these cases are of all eyelid metastases.
Why this evidence level: This was a systematic review using a stated search and appraisal process, which strengthens the completeness of the evidence summary. However, the underlying evidence came only from case reports and case series, with no comparison group, so it cannot establish diagnostic accuracy, causes, or typical outcomes for all patients.
Evidence levels are editorial estimates derived from study metadata — they are not clinical appraisals.
// Source
Graefe s Archive for Clinical and Experimental Ophthalmology · 2026 · DOI: 10.1007/s00417-026-07449-0
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