Eyelid Tumours: BCC, SCC, Sebaceous Gland Carcinoma and Melanoma
Last updated: November 2026
Most lid lumps are benign, but missing a malignancy costs the lid, the eye and sometimes the life. Learn the warning signs, and biopsy anything that does not behave as expected.
Warning signs of malignancy
- Loss of lashes (madarosis) and destruction of the lid margin architecture.
- Ulceration, bleeding, pearly rolled edges, telangiectasia.
- Slow, painless growth; induration; a "chalazion" that recurs in the same place, especially in older adults.
- Unilateral chronic blepharoconjunctivitis that does not respond to treatment (sebaceous carcinoma).
Malignant tumours
| Tumour | Key features | Treatment |
|---|---|---|
| Basal cell carcinoma | The commonest (about 90% of lid malignancies in Western series); lower lid and medial canthus; nodular, pearly, rolled edge; rarely metastasises | Excision with margin control (frozen section or Mohs), then reconstruction; vismodegib for advanced disease |
| Sebaceous gland carcinoma | Relatively common in India and Asia; upper lid; masquerades as chalazion or chronic blepharitis; pagetoid spread | Wide excision with map biopsies of the conjunctiva; check regional nodes; can metastasise |
| Squamous cell carcinoma | Keratotic, ulcerating; arises from actinic keratosis; perineural spread | Wide excision with margin control; nodal assessment |
| Melanoma | Pigmented, irregular, changing lesion | Wide excision, sentinel node biopsy with oncology input |
| Merkel cell carcinoma | Rapidly growing violaceous nodule in older adults | Urgent excision and oncology referral |
Common benign lesions
- Chalazion, papilloma, seborrhoeic keratosis, cysts (sebaceous, of Moll and Zeis), xanthelasma (check lipids), naevi, molluscum (umbilicated, may cause follicular conjunctivitis).
Principles
- Incisional biopsy for suspicious lesions before major surgery; excisional biopsy for small lesions.
- Margin-controlled excision then reconstruction (direct closure, Tenzel flap, Hughes or Cutler-Beard flaps).
- Long-term follow-up for recurrence and new lesions.
Where residents slip
- Curetting a recurrent "chalazion" again and again without histology.
- Missing sebaceous carcinoma presenting as unilateral blepharitis.
- Excising a malignancy without margin control.
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Related: Eyelid Malpositions: Entropion, Ectropion, Trichiasis and Chalazion, Ocular Tumours: Eyelid, Conjunctiva, Uvea and Orbit, Oculoplasty.
Key sources
- Yin VT, Merritt HA, Sniegowski M, Esmaeli B. Eyelid and ocular surface carcinoma: diagnosis and management. Clin Dermatol. 2015;33:159-169
- Kaliki S, et al. Eyelid sebaceous gland carcinoma: clinical features and outcome in 191 Asian Indian patients. Ophthalmic Plast Reconstr Surg (2015)
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