Eyelid lumps and bumps are commonly found during routine examinations by eye care providers, such as Optometrists or Contact Lens Opticians, GPs, and Dermatologists.
Establishing the diagnosis, and distinguishing what is serious, and what is non-serious can be a challenge.
The majority of eyelid lumps and bumps are benign such as styes, chalazion and cysts, however they can be a sign of something more serious such as a tumour.
Benign Eyelid Tumours
Benign eyelid tumours can be inflammatory, infectious, traumatic, or neoplastic in origin. They are a common condition that requires differentiation from malignant and pre-malignant lesions.
Benign neoplastic lesions include squamous cell papilloma, epidermal inclusion cyst, dermoid/epidermoid cyst, acquired melanocytic nevus, seborrheic keratosis, hidrocystoma, cyst of Moll and Zeiss, and xanthelasma.
Many less common lesions can mimic the more common ones. All benign lesions need to be differentiated from pre-malignant lesions that include actinic keratosis and keratoacanthoma, as well as malignant lesions that include basal cell carcinoma, squamous cell carcinoma, sebaceous carcinoma, Merkel cell carcinoma, metastatic lesions, cutaneous lymphoma, and melanoma.
When do you leave alone and when do you treat?
Any suspicious skin lesion should be biopsied to determine if it’s cancerous or non-cancerous, the earlier the better.
Red flags to look out for include:
- Lash Loss
- Destruction of eyelid margin
- Unilateral blepharitis
Treatment options include different types of laser, curettage, cryotherapy and shave excision.
Malignant Eyelid Tumours
Malignant eyelid tumours may appear similar to, and in many cases arise from, benign or pre-malignant lesions. The most common include basal cell and squamous cell carcinoma. Other malignant eyelid lesions such as Merkel cell carcinoma, melanoma, sebaceous carcinoma, lymphoma, and metastatic cancer are less common.
Basal cell carcinoma (BCC) or rodent ulcer – is the most common skin cancer with 19 out of 20 eyelid skin cancers BCCs. They typically present as a slow developing, non-resolving lesion with ulceration on the eyelid or medial canthus, but are usually painless. They do destroy the normal eyelid in the area and so need to be treated.
Squamous cell carcinoma (SCC) – is the second most common eyelid skin cancer. They grow faster than BCCs, and 1 in 20 may spread to lymph nodes in the neck. The tumour may be clinically indistinguishable from a basal cell carcinoma (BCC), but usually it does not have superficial vascularisation, it grows more rapidly, and hyperkeratosis is more frequent.
Sebaceous carcinoma – typically presents as a yellow or pink painless mass along the eyelid margin originating from sebaceous glands such as meibomian glands or glands of Zeis. It can also cause loss of eyelid architecture including eyelash loss, margin scarring or notching, and mass formation.
Merkel cell carcinoma – is a rare, highly malignant neuroendocrine tumour. They often present as a painless solitary nodule with a “violaceous” (purple-red) colour. Occasionally, the tumour may ulcerate and satellite lesions can develop.
Melanoma – arises from melanocytes (pigment-producing cells) and typically appears as a pigmented thickening or growth on the eyelid. A cardinal sign of melanoma is gradual changes over time, chaotic and disorganised pigmentation, and a change in colour, shape or size.
Treatment modalities for malignant tumours and lesions include cryotherapy, radiotherapy, chemotherapy, excision with histological control of margins including fast paraffin and MOHS’ micrograph surgery.
Eyelid reconstruction surgery – after a lesion has been removed the eyelid needs to be reconstructed by an experienced surgeon.
Complimentary Eyelid Lumps and Bumps CPD Event
If you are an Optometrist, Contact Lens Optician, GP or Dermatologist, you won’t want to miss this interactive and informative session on ‘Eyelid lumps and bumps – how to recognise causes for concern and methods of treatment’, with the opportunity to ask questions.
Expert: Consultant Ophthalmic and Oculoplastic Surgeon, Mr Hugo Henderson
Where: The London Clinic
When: Thursday 8 May, 6pm to 8pm
Find out more and secure your place: here.
Mr Hugo Henderson
Consultant Ophthalmic and Oculoplastic Surgeon, Mr Hugo Henderson, practices at the NHS Royal Free London Hospital managing complex facial surgery.
Mr Henderson is a member of the Royal Free multi-disciplinary Sub-Cranial Facial Surgery team, and runs the multidisciplinary Thyroid Eye Disease Clinic.
Mr Henderson also works privately at The London Clinic in Harley Street where he specialises in ophthalmic and reconstructive plastic surgery, and aesthetic procedures such as cosmetic eyelid surgery and brow lifts, and was honoured to host the prestigious annual meeting of the British Oculoplastic Surgery Society 2017 in London.
Find out more and how to refer a patient to Mr Hugo Henderson.