Objective To review the management of malignant eyelid tumors with primary reconstruction and the long-term outcomes. Methods Retrospective case study. The data from 46 eyes with malignant eyelid tumors were analyzed in patients who had undergone surgical excision from 2005 to 2008 in Shanghai Eye and ENT Hospital. The cancer type， location， extension， type of the procedure， appearance after surgery， comfort level and survival rate were evaluated. Results Among 46 cases， basal cell carcinoma （21 cases）， sebaceous gland carcinoma （19 cases）， squamous cell carcinoma （4 cases）， lymphoma （1 cases） and Merkel cell carcinoma （1 case） were included. Various techniques were used， such as the Hughes procedure， Cutler-Beard reconstruction， myocutaneous advancement flap， semicircular rotational flap， lateral cantholysis， periosteal strip， free autogenous tarsal graft， full-thickness skin graft， glabellar flap， et al. Median follow-up was 59.7±12.9 months （15-84 months）. According to the Kaplan-Meier survival estimate， the overall five-year and seven-year survival rates were 94% and 91%， respectively. The five year tumor-free survival rate was 91%. During the follow-up period， local recurrence occurred in two patients who refused further treatment and they were still alive at the last follow-up. Cervical lymph node enlargement was detected in two cases， followed by lymph node debridement. Both of them were in good condition until now. Four patients died， two of metastasis， one of old age， and one of primary esophageal carcinoma. Conclusion Eyelid reconstruction techniques can effectively repair defects after resection of malignant eyelid tumors and lead to satisfactory clinical results. Active surveillance is still mandatory.