Examqo › Examqo library › Ophthalmology › Orbit, eyelids and lacrimal · IMLE
Eyelid lesions and tumours
Most eyelid lesions are benign — chalazion, stye and common skin lesions — but loss of lashes, ulceration and destruction of the lid-margin architecture are signs of malignancy; basal cell carcinoma is the commonest malignant tumour, and sebaceous gland carcinoma is the dangerous masquerader — a chalazion that recurs in the same place in an older adult needs a biopsy.
Why it matters in the exam
A chalazion is a non-infectious granulomatous inflammation around a blocked meibomian gland: a painless lump in the lid, treated with warm compresses, and if it does not resolve — steroid injection or incision and curettage. A stye (hordeolum) is an acute painful abscess, usually from Staphylococcus. Xanthelasma — a yellow plaque at the inner corner; about half of patients have normal lipids, but a lipid profile is checked. Molluscum contagiosum on the lid margin causes chronic follicular conjunctivitis.
Basal cell carcinoma — about 90% of malignant eyelid tumours, mainly in the lower lid and the inner corner: a pearly nodule with telangiectasia and central ulceration; it almost never metastasises, but at the inner corner it invades deeply into the orbit. Squamous cell carcinoma — more aggressive, with perineural and lymph node spread. Sebaceous gland carcinoma — in the upper lid, in an older woman, masquerading as a recurrent chalazion or chronic unilateral blepharoconjunctivitis, spreading within the epithelium (pagetoid) and with high mortality; linked to Muir-Torre syndrome. Melanoma and Merkel cell carcinoma (a fast-growing red-violet nodule) are rare and dangerous.
Treatment of a malignant tumour: complete excision with margin control — Mohs surgery or frozen sections — and eyelid reconstruction. At the inner corner and in recurrent tumours Mohs is preferred. In sebaceous carcinoma mapped conjunctival biopsies and lymph node assessment are needed. For advanced unresectable tumours there are hedgehog inhibitors (vismodegib) for BCC and immunotherapy for other tumours.
Key points
- Most lesions are benign: chalazion, stye.
- Signs of malignancy: lash loss, ulceration, destroyed lid margin.
- BCC: about 90% of malignancies, lower lid and inner corner.
- Sebaceous gland carcinoma: upper lid, masquerades as chalazion.
- Treatment: excision with margin control.
Summary table
| Lesion | Clues | Treatment |
|---|---|---|
| Chalazion | Painless lump, blocked gland | Warm compresses; injection or curettage |
| Hordeolum | Painful red lump | Compresses; drainage if needed |
| Basal cell carcinoma | Lower lid, pearly, ulcer, telangiectasia | Excision with margin control (Mohs) |
| Squamous cell carcinoma | Scaly lump, perineural spread | Wide excision, node assessment |
| Sebaceous gland carcinoma | Upper lid, recurrent chalazion, older woman | Full biopsy, excision, conjunctival mapping |
A free exam question
מה מהבאים אינו מהווה התוויה מקובלת לביצוע ניתוח MOHS? (the question as examined, in Hebrew)
- א. SCC במיטת הציפורן
- ב. מדוכא מערכת חיסון עם SCC באמה בעומק 2 ס"מ
- ג. BCC באזור שעבר הקרנה בעבר
- ד. DISCONTINUOUS (MULTIFOCAL) BCC.
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Sources
- AAO Basic and Clinical Science Course, Section 7: Oculofacial Plastic and Orbital Surgery, 2024-2025 — Eyelid neoplasms
- NCCN Guidelines: Basal Cell Skin Cancer, 2025 — Treatment of high-risk sites
- Kanski's Clinical Ophthalmology, 9th edition (2020) — Eyelids
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-06. The text may contain errors; when in doubt, check the source.