Eyelid Lesions & Skin Cancers

The eyelids are composed of delicate skin and are among the most sun exposed areas of the body. This makes them a common site for both benign and malignant growths. Ultraviolet (UV) exposure over a lifetime is the primary risk factor, with fair skin, older age, and immunosuppression also contributing.

Eyelid lesions can be benign, premalignant, or malignant. Benign lesions include styes, chalazia, skin tags, moles, and cholesterol deposits. Premalignant lesions such as actinic keratosis have the potential to become cancerous if left untreated.

Malignant lesions are skin cancers that can invade surrounding tissues and, in some cases, spread to other parts of the body. Basal cell carcinoma is the most common eyelid malignancy, typically appearing as a pearly nodule with rolled borders. Squamous cell carcinoma is less common but more aggressive, often presenting as a scaly or rapidly growing lesion. Sebaceous gland carcinoma is a rare but aggressive tumour that can mimic a chalazion, while melanoma carries the highest risk of metastasis and requires urgent management.

Any new or changing lesion on the eyelid warrants attention. Signs to watch for include:

• A new growth or lump on the eyelid
• A lesion that is growing, bleeding, or crusting
• Loss of eyelashes around the lesion
• Ulceration or an area that does not heal
• Distortion of the eyelid margin
• A pigmented lesion that changes in size, shape, or colour
• A lesion that is painful or itchy
• Thickening or hardening of the eyelid
• Any lesion that does not resolve with treatment

When you visit us at Sutherland Eye Surgeons, some of the tests that we perform may include:

• External eyelid examination
  Assessment of the lesion's size, shape, colour, borders, and any associated features such as ulceration, bleeding, or loss of eyelashes

• Dermoscopy
  Magnified examination of the lesion using a specialised instrument to assess subtle features

• Slit lamp examination
  Microscopic evaluation of the eyelid margin, conjunctiva, and ocular surface

• Palpation
  Assessment of the lesion's consistency, mobility, and any involvement of underlying tissues

• Photographic documentation
  Baseline photographs to monitor for changes over time

• Biopsy
  If there is any suspicion of malignancy, a biopsy is performed to obtain a tissue diagnosis. This may be an incisional biopsy (removing a portion of the lesion) or an excisional biopsy (removing the entire lesion). The tissue is sent for histopathological evaluation to confirm the diagnosis and determine whether clear margins have been achieved

The approach depends on the type, size, and location of the lesion, as well as the pathology results.

Benign lesions
These may be observed if they are stable and not causing symptoms. If they are symptomatic, growing, or cosmetically concerning, simple excision can be performed.

Premalignant lesions
These are typically excised with a margin of surrounding normal tissue to ensure complete removal and prevent progression to malignancy. Topical treatments or cryotherapy may be options for selected cases.

Malignant lesions
Treatment involves complete excision with clear margins to ensure the cancer is fully removed. Following excision, our oculoplastic specialists perform meticulous eyelid reconstruction to restore both function and appearance. This may involve direct closure, local skin flaps, tarsoconjunctival grafts, or full thickness skin grafts. The goal is to ensure the eyelid closes properly, protecting the cornea while achieving the best possible cosmetic outcome.