Eyelid Lumps?

  • Chalazion
  • Swelling of a meibomian gland in the eyelid.
  • Often confused with a stye or hordeolum (an infection of the lash follicle).
  • Caused by inflammation due to trapped oil secretions
  • Small chalazia may resolve on their own; large ones can cause blurred vision, discomfort, and eyelid swelling, possibly requiring antibiotics.
  • Persistent chalazia can lead to thickening of the eyelid, complicating treatment.

Papilloma/Seborrhoeic Keratoses

  • Eyelid papilloma: smooth, rounded, or pedunculated lesions, likely viral, similar to warts.
  • Seborrhoeic keratoses: non-viral "senile warts.
  • Other benign or malignant lesions, such as basal cell or squamous cell carcinoma or melanoma, can resemble these.

Xanthelasma

  • Soft yellowish plaques under the skin of the eyelid.
  • Associated with conditions like hyperlipidemia, familial hypercholesterolemia, primary biliary cirrhosis, menopause, diabetes, and normo-cholesterolemic patients.
  • Linked to an increased risk of coronary heart disease.

Cyst

  • Common types include sebaceous cysts, cysts of Moll (benign, non-tender, from apocrine sweat glands), and cysts of Zeiss (containing oily secretions).
    - Malignant lesions, such as basal cell carcinoma, can mimic these cysts.

How can a chalazion be treated?

  • Warm Compresses and Eye Lid Massage
  • Apply twice daily: use a hot washcloth or a heated object (e.g., wrapped boiled egg or potato) to the eyelids for 10 minutes. Avoid burns.

Steroid Injections

  • Effective for new chalazia; performed in a clinic with topical anaesthesia.

Surgery

  • Involves incision and drainage of the lump.
  • A simple 10-minute procedure usually done under local anaesthesia. Post-surgery care includes information on time off work, bandages, dressings, and hygiene.

Faq

1How do I know if the growth or lump on my eyelid skin is cancerous?

As a consultant oculoplastic surgeon Mano Sira is an expert in diagnosing eyelid tumours however it is often not possible to determine this from appearance alone. Features of concern include eyelash loss, ulceration, persistent crusting, bleeding, or non-healing lesions. A biopsy is the only definitive test.

Eyelid tumours are abnormal growths affecting the upper or lower eyelid. They may be benign (non-cancerous) or malignant (cancerous). Malignant tumours can invade nearby tissues and may spread (metastasise). Because the eyelids are exposed to sunlight and have unique anatomical features, they are a common site for both benign growths and skin cancers. Early assessment is essential, as malignant lesions may extend deeper than is visible.

Types of Eyelid Tumours

Benign Lesions

Common benign lesions include:

  • Cysts
  • Skin tags
  • Moles

These can resemble malignant lesions; in uncertain cases, biopsy is recommended.

Malignant Tumours

1. Basal Cell Carcinoma (BCC)

  • Most common eyelid cancer (≈90% of malignant eyelid tumours).
  • Appears as a raised, pearly lesion, often on the eyelid margin.
  • Rarely spreads elsewhere but can cause significant local tissue destruction.
  • More common in fair-skinned and older individuals.

2. Squamous Cell Carcinoma (SCC)

  • More aggressive and capable of metastasis.
  • May appear as a scaly or ulcerated lesion with hard raised edges.
  • Early diagnosis is associated with high cure rates.

3. Sebaceous Gland Carcinoma (SGC)

  • Rare but aggressive tumour of the eyelid oil glands.
  • Often misdiagnosed as chalazion or blepharitis.
  • Suspicion should be raised if there is a non-resolving chalazion, unilateral chronic blepharitis, eyelash loss, or persistent crusting.

Symptoms

Early eyelid tumours may show no symptoms. As they develop, signs may include:

  • Raised lumps (pigmented or non-pigmented)
  • Skin breakdown, crusting, bleeding
  • Ulceration
  • Loss of eyelashes
  • Local discomfort or irritation

Advanced disease may cause:

  • Lymph node swelling around the ear or under the chin
  • Pain around the orbit
  • Reduced or double vision
  • Eye displacement

Causes and Risk Factors

The exact cause is often unknown, but risk factors include:

  • Excessive sun exposure, especially in fair-skinned individuals
  • Genetic predisposition
  • Immunosuppression
  • Pre-malignant skin conditions such as actinic keratosis, Bowen’s disease, and keratoacanthoma

Possible Complications

Although eyelid tumours are relatively uncommon and often slow-growing, they can:

  • Damage nearby eye structures
  • Affect eyelid function (e.g., incomplete closure, dry eye)
  • Cause double vision
  • Rarely lead to blindness
  • Spread elsewhere if malignant and untreated

Diagnosis and Management

Diagnosis involves:

1. Medical history and clinical examination

2. Biopsy for definitive diagnosis (local anaesthetic, tissue sample sent for histology). Results typically return within a week.

Based on the biopsy:

  • Benign lesions may require no treatment unless symptomatic.
  • Malignant tumours require further planning, possibly including scans or blood tests.

Surgical management includes:

  • Excision of the tumour
  • Reconstruction of eyelid tissues after removal

Excision may be performed with:

  • Mohs micrographic surgery (stepwise excision with margin control)
  • Standard surgical removal with a margin of normal tissue

Treatment Options

Non-Surgical

  • Topical chemotherapy
  • Topical immune modulators
  • Cryotherapy
  • Laser therapy
  • Radiotherapy

Surgical

  • Complete tumour excision (via Mohs or conventional surgery)
  • Reconstruction using direct closure, flaps, or grafts depending on defect size

Systemic Chemotherapy

Used in advanced or metastatic disease.

Mohs’ Surgery

Mohs’ surgery involves:

1. Removing tissue suspected of containing the tumour

2. Examining each layer under the microscope

3. Repeating removal only where tumour cells remain

Advantages:

  • Highest cure rates
  • Spares maximum healthy tissue—critical in delicate areas like the eyelid

Reconstruction

Eyelid reconstruction is performed after tumour removal. Defects may be:

  • Small — closed directly
  • Large — repaired using flaps or grafts

Eyelid tissues generally heal well because of excellent blood supply.

Post-Operative Care

Patients receive:

  • Aftercare instructions
  • Scheduled follow-up to monitor healing
  • Advice regarding surveillance for recurrence

See below, Mano Sira’s answers to common questions about eyelid tumours.

2What is an eyelid tumour?
An eyelid tumour is an abnormal growth on the upper or lower eyelid. It may be benign or malignant; malignant tumours can invade surrounding tissues and may spread.
3How can I tell if an eyelid lesion is cancerous?
It is often not possible to determine this from appearance alone. Features of concern include eyelash loss, ulceration, persistent crusting, bleeding, or non-healing lesions. A biopsy is the only definitive test.
4What are the most common eyelid cancers?
  • Basal cell carcinoma (most common)
  • Squamous cell carcinoma
  • Sebaceous gland carcinoma (rare but serious)
5What symptoms should I look for?
  • New or growing lumps
  • Skin changes such as crusting, scaling, ulceration
  • Loss of eyelashes
  • Bleeding or irritation
  • Later stages may cause vision changes or pain
6What increases the risk of eyelid cancer?
  • Excess sun exposure
  • Fair skin
  • Weakened immune system
  • Pre-cancerous skin conditions
  • Genetic factors
7How are eyelid tumours diagnosed?

Through:

  • Clinical examination
  • Biopsy of the lesion
  • Occasionally scans or blood tests for staging in malignant cases
8Do all eyelid tumours need treatment?
No. Benign lesions may not need treatment unless they cause discomfort, visual problems, or cosmetic concern. Malignant tumours always require treatment.
9What are the treatment options?

Treatments may include:

  • Topical chemotherapy or immune therapy
  • Cryotherapy
  • Laser therapy
  • Radiotherapy
  • Surgical excision
  • Systemic chemotherapy for advanced disease
10What is Mohs’ micrographic surgery?
A precise surgical technique that removes cancer layer by layer, examining each under the microscope. It ensures complete tumour removal while conserving healthy tissue and is usually completed during a single admission. Mohs’ surgery is perf
11Why is reconstruction needed after tumour excision?
Tumours often extend deeper than they appear. Reconstruction restores eyelid function and appearance, using direct closure, flaps, or grafts.
12What is recovery like?

Most patients require:

  • Several weeks of healing
  • Regular follow-up
  • Monitoring for recurrence

Pain is usually manageable, and eyelids often heal well thanks to their rich blood supply.

13What complications can occur if a tumour is untreated?
  • Local tissue destruction
  • Impaired eyelid function
  • Vision problems
  • Rarely, spread to lymph nodes or other organs
14When should I seek medical assessment?

If you notice:

  • A new eyelid lump
  • A lesion that doesn’t heal
  • Persistent or unilateral blepharitis
  • A “chalazion” that does not resolve
  • Loss of eyelashes

Early evaluation improves outcomes.