Eyelid
The second most common eyelid cancer — keratotic, indurated lesions with a higher risk of spread, and their surgical treatment.
Medically reviewed by Ronald W. Kristan, MD, FACSOculoplastic SurgeonLast updated June 2026
Your Surgeon
Ronald W. Kristan, MD, FACS
Atlantic Eye
Part of our complete guide to Eyelid Skin Tumors — this page covers squamous cell carcinoma in depth.
Squamous cell carcinoma (SCC) is the second most common eyelid malignancy, accounting for ~5–10% of eyelid cancers. It arises from keratinocytes of the epidermis and has a significantly higher metastatic potential than BCC — regional lymph node metastasis occurs in 1–24% of periocular SCC depending on subtype, depth, and location.
Risk factors: cumulative UV exposure, actinic keratosis (precursor lesion), immunosuppression (solid organ transplant recipients have a dramatically increased risk), xeroderma pigmentosum, chronic inflammation or scarring, and prior radiation therapy.
Clinical appearance: SCC often arises within an actinic keratosis and presents as an indurated, erythematous, scaly plaque that may ulcerate. Unlike BCC, the border tends to be less well-defined and the lesion may feel firm or fixed to deeper structures. The lower lid and lid margin are common sites.
High-risk features that increase recurrence and metastasis risk: perineural invasion, tumor thickness > 2 mm, poorly differentiated histology, recurrent lesion, immunosuppressed host, and location at the lid margin or medial canthus. High-risk periocular SCC warrants sentinel lymph node biopsy or elective parotid/neck imaging.
Treatment: Mohs surgery with same-day reconstruction is preferred for primary periocular SCC. Wide local excision with frozen-section control is an alternative. Adjuvant radiation therapy is used for perineural invasion, positive margins that cannot be cleared surgically, or regional nodal disease. Anti-PD-1 therapy (cemiplimab) is approved for locally advanced or metastatic SCC not amenable to surgery or radiation.
Schedule a consultation with Ronald W. Kristan, MD, FACS to learn if this procedure is right for you.
