lump bump eyelid basal cell carcinoma
Downloaded from Stockvault, no need for attribution

This is actually a bit of an odd story. A while back, my grown-up son decided to get the small lump on his lower eyelid checked out. His doc really didn’t think it was much of anything but decided to remove it. Luckily, he sent the specimen to pathology. It turned out to be a skin cancer – a basal cell carcinoma to be exact.

Related: Skin Cancer can Increase the Risk of Other Cancers

Fast forward, one year later

Fast forward, about a year later, I find a teensy tiny lump on my lower lid. Even though it seemed unlikely that my son and I would both have basal cell cancers of the lower lid, I decided to get it checked out.

The dermatologist I went to was sure it was just a cyst. She took a scalpel and cut it off. However, she did not send the specimen to pathology. In retrospect, this was a mistake.

Four or five months later, the little lump returned so I went back to her. Again, she didn’t think it was much of anything (an indication of how benign these things look), but she agreed to send me to the ophthalmologist for a second opinion.

Basal cell cancer of lower lid
Basal cell cancer of the lower lid | via envisagebavarea

What did the pathologist find?

Initially, the ophthalmologist couldn’t see the lesion even with a slit lamp. But once I pointed it out, he also thought it was just a cyst and, therefore, no big deal.

He tried to drain it with a hypodermic needle but was unable to extract any fluid. So he said, “I can take it off and send it to pathology if you like.” I agreed. He numbed it up and cut it out. It healed beautifully in a few days—no visible scar.

Well, guess what? The pathology report returned a basal cell carcinoma. The biopsy made the diagnosis.

Too weird…Like son, like a mother?

Related: What You Need to Know About Basal Cell Carcinoma

What are some general characteristics of eyelid cancers?

Eyelid cancers can be difficult to recognize because they tend to grow inward. They often grow under the skin for years before finally appearing on the surface. Even when the cancer appears on the surface of the lid, its appearance may not suggest cancer. 

More than 10% of people later proven to have cancer of the eyelid, initially reported only “altered appearance” of the lid, a red spot, or ingrown lashes. Luckily, most people present with a more typical “warning sign,” such as a lump or a sore that doesn’t heal.

Forty-four percent of eyelid cancers, in one study, occurred on the lower eyelid with another 20% in the area of the medial canthus (see graphic below).

Why types of skin cancers appear on the eyelid?

The eyelid area is a common site for skin cancers. In fact, eyelid cancers account for about 5-10% of all skin cancers. Most non-melanoma skin cancers have low rates of spread (metastasis). But when they occur around the eye, they can wreak havoc because the skin is thin in this area. The tumor can, therefore, affect nearby tissues, such as the bony orbit or nasal cavities.

Basal cell carcinoma (BCC) is the most common type of skin cancer that occurs on the eyelid. In non-Asian countries, it accounts for 85–95% of all eyelid cancers. Most cases involve the lower eyelid and inner canthus. It usually occurs in adults and almost always as a solitary lesion. It is usually painless but can be accompanied by the loss of lashes.

The most common type of basal cell carcinoma is called nodular. It appears as a raised, firm, pearly nodule. If you look closely you may see small spidery blood vessels on its surface (telangiectasia). These lesions can ulcerate as they grow larger. 

Basal cell carcinomas are unlikely to metastasize (spread to lymph nodes or distant organs). However, they can spread locally and cause significant damage to the eyelid and surrounding structures. Also, they can recur in the same area or nearby if the entire tumor is not removed. The margins of the excised tumor must be clear of cancer. Prolonged exposure to ultraviolet (UV) light is the most important risk factor.

 

Eyelid basal cell cancer
Ulcerating basal cell cancer of lower lid | via envisagebayarea

Squamous cell carcinoma (SCC) is a relatively uncommon cause of eyelid cancer comprising only 5% of all eyelid cancers. However, it is more aggressive than BCC. It can spread to nearby lymph nodes and other parts of the body.

SCCs mainly affect older fair-skinned people. As is true with basal cell lid cancers, one of the main risk factors is exposure to UV light. Further, it may arise from pre-existing skin lesions, such as:

          • actinic keratosis
          • xeroderma pigmentosa
          • carcinoma in situ
          • following radiotherapy

Surgical removal is the primary treatment for this type of eye cancer. Radiation therapy or other treatments may be used in addition to surgery if a large area is affected or if the tumor cannot be fully removed.

Sebaceous carcinoma (cancer of the oil glands) is a rare type of eye cancer that affects the meibomian glands of the eyelids, conjunctiva or other ocular surface structures. These glands normally produce the oily layer of the tear film, the liquid layer that covers the eye.

It can be mistaken for a stye (a non-cancerous lesion of the eyelid that is also called a chalazion). If a stye does not heal with medical treatment or surgical drainage, it should be biopsied.

Treatment requires surgical removal. The defect in the eyelid can be reconstructed afterward using various techniques depending on the size and location of the tumor. Sometimes topical chemotherapy is used after the surgical area has healed.

ADD_THIS_TEXT
 

Melanoma is a potentially life-threatening type of skin cancer. Luckily, it accounts for only about 1% of eyelid cancers. This type of cancer can affect the eyelid skin or the conjunctiva (the tissue that covers the white part of the eye).

Like SCCs, this cancer occurs primarily in older fair-skinned individuals. It may occur de novo or it may evolve out of an existing pigmented lesion that grows and changes its shape and color.

It is very aggressive and may present with early metastasis in the nearby lymph nodes that drain an eyelid or conjunctival melanoma. Sentinel lymph node biopsy can help stage melanomas of the eyelid and conjunctiva. 

Related: Why You Probably Don’t Need to Worry About Getting Cancer

MOHS Surgery is the treatment of choice for nonmelanoma skin cancers

Although many people will have eyelid lumps and bumps removed by standard surgery, the treatment of choice for basal cell and squamous cell carcinomas is MOHS Micrographic Surgery (microscopically controlled surgery). This is because it can best preserve the complex and delicate structures around the eye.

The procedure is done in stages by specially trained surgeons in an outpatient surgical suite with laboratory facilities. A small layer of tissue is resected and examined under the microscope to see if there is any suggestion that cancer cells may still be in the skin. If so, the surgeon removes another small layer of tissue from the area where the malignant cells remain. The procedure is continued until all evidence of the cancer is removed.

Because it is done in stages, with careful dissection and examination, the amount of tissue removed is the smallest amount possible that allows for complete resection of the cancer. Cosmetic results are usually quite good.

Distribution of eyelid skin cancer
Skin Cancer Foundation graphic-distribution of eyelid skin cancers

Recurrence after standard surgery or radiation treatment is between 5-30% but falls to 2% or less after MOHS surgery.

Preventing eyelid cancers

A major contributor to eyelid cancers, as is true of all other skin cancers, is UV radiation (both UVA and UVB). Prescription eyeglasses and sunglasses with UV protection are important prevention measures.

So is the application of sunscreen. Be careful though, as anyone who has ever gotten sunscreen in their eyes knows that this can be irritating at best and painful at worst.

The bottom line

If you find a lump, bump, red spot, or sore that won’t heal in the eyelid area, you should make an appointment with a dermatologist or ophthalmologist.

If they say, “no big deal,” ask them to cut it off anyway. Be sure to tell the doctor that you want it sent to pathology.

Is this overreacting? I don’t think so. Eyelid cancers are tricky, risky, and, for the most part, completely curable if caught early and treated appropriately.


Originally published on October 19, 2011, this post was updated by the author on 5/7/17 and again on 4/22/2020.

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Patricia Salber MD, MBA (@docweighsin)

Patricia Salber, MD, MBA is the Founder and Editor-in-Chief of The Doctor Weighs In. Founded in 2005 as a single-author blog, it has evolved into a multiauthored, multi-media health news site with a global audience. She has been honored by LinkedIn as one of ten Top Voices in Healthcare in both 2017 and 2018.

Dr. Salber attended the University of California San Francisco for medical school, internal medicine residency, and endocrine fellowship. She also completed a Pew Fellowship in Health Policy at the affiliated Institute for Health Policy Studies. She earned an MBA with a health focus at the University of California Irvine.

She joined Kaiser Permanente (KP)where she practiced emergency medicine as a board-certified internist and emergency physician before moving into administration. She served as the first Physician Director for National Accounts at the Permanente Federation. She also served as the lead on a dedicated Kaiser Permanente-General Motors team to help GM with its managed care strategy. After leaving KP, she worked as a physician executive including serving as EVP and Chief Medical Officer at Universal American.

She has served as a consultant or advisor to a wide variety of organizations including digital start-ups such as CliniOps, My Safety Nest, Doctor Base. She currently consults with Duty First Consulting as well as Faegre, Drinker, Biddle and Reath, LLP.

Pat serves on the Board of Trustees of MedShare, a global humanitarian organization. She is also Chair of MedShare's Western Regional Council.

54 COMMENTS

  1. Hello after reading your article I have a question that I didn’t see asked. I have a small lump under my left eye lash line that if I look inside the eye I can feel the lump as well. When it first appeared several months ago it felt like a pimple a couple months still dealing with it I squeezed it and a white pus like came out. I have been a stage IV melanoma patient for 15 years now in remission so to speak. Do you know the possibility of it being cancer also or not likely? Should I get it looked at by my oncologist or dermatologist? Thanks so much!

  2. A had a very tiny skin tag that has grown into a mole like bump that is red and hard in the last 3 weeks, it was also bitten by an ant, which I think caused to to swell up. I just had breast cancer and lymph node cancer surgery, chemo & radiation last year. I fear this is cancer, everything is on my left side. This Friday I see a Kaiser PA dermatologist, and I am waiting for an ophthalmologist to make an appt with. I’d send a picture if I could, but it is a scary thing not knowing. I don’t want my eyeball to be damaged during any surgery near my eye. Do they put some type of a metal protecter lining your eyeball before they cut these bumps out from your eyelids?

    • You have made good decisions to see a dermatologist and ophthalmologist. If they decide you need to have it removed, they may recommend MOHS surgery. This is a carefully controlled biopsy that only removes a small amount at a time until the margins are clear. It should not damage your eyeball. I had my basal cell removed from my lower lid with no problem related to my eyeball.

      Hang in there. You will know more in a few days. Pat

  3. I had a lump on my eye lid. For 12 months. It got bigger. It turned out to be a cyst inside my eye lid. I looked at the inside of my eye lids. Gross I know. My doctor lanced it. It keeps coming back every now and then. Always go to the doctor. First point of call. I was lucky it wasnt more serious.

  4. I had what looked like a stye at first on my lower eyelid. It was painful and got worse over the course of a couple of weeks. Then it drained and got somewhat better. What was left was a small bump that doesn’t hurt. Can eyelid cancer be masked by a stye at first or look like one initially? I’ve seen an optometrist and ophthalmologist. They both think it was a bad stye that is being stubborn and going away very slowly.

  5. Thanks for sharing your thoughts. lumps and bumps on eyelid irritation caused by eye allergies and infections. I think surgery is very safe and effective, accessible for treating droopy eyelid rather than other treatment.

  6. Illuminating – I feel affirmed that I’m not over-reacting – The lump on my right lower eye lid is going outwards -has not responded to antibiotic cream or abraiding -not a stye – hot compresses and squeezing -not the meiboam glands- I have mild dry eyes since cataract removal and new lens surgery twelve months ago.
    My skin specialist has now sent me to an eye specialist next Thursday for biopsy and removal – It wakes me in the night and i’m constantly aware of it – I’m so glad I mentioned as a ‘bye the way can you have a look at this please ten days ago when presenting for a routine skin check and some early scg;s frozen off — Will be six weeks since appearance and looks like a white match head — My gut feeling is its cancerous .. Thanks for blogging — I’m an allied health professional now with a mixed dementia but living exuberantly beyond it.. my story is ‘Eager to Share Bold as a Hyena’ -Always a community educator too…

    • Hi Antoinne,

      We do not offer medical advice on this site. However, we do strongly advise that you seek care from a licensed health professional when you have health concerns. We hope your eyelid problem is resolved without issue.

  7. My left eye was itching to I rubbed it and a lot of dryer mucus came out but I looked. Closer at the bottom of me bottom eye lid but it was located on the far left closest to my ear, I seen a very small pimple as tiny as a pin head so I wiped it out and washed my eye this started on Nov 1st 2017 my eye still hurts i’m Going to start putting eye gel in my eye every day and see if that helps if not I will go to the doctor.

  8. Recently I have experienced a heavy upper left eyelid and felt also like something was rubbing similar to getting grit in the eye. Over the last weeks it became more irritable. I rolled my eyelid and have found a red lump directly under the lid but not close to the rim. This is the third week now and still there. I feel it is a minor problem to take to a doctor. Should I seek advise?

  9. HI I had a punctal plug inserted in my lower left eye on March 17 which became itchy. My regular opthamologist was not available so a saw his colleague. He pressed on something and said he got something out, then recommended lid scrubs, warm compresses and massage. It remained irritated and I stupidly over massaged it a couple nights later. When it appeared to look worse, I called again and saw another colleague who said to leave it alone and it would resolve in a week. After two weeks with continued redness and irritation, he finally prescribed me Lotamax ointment for 7 days which did nothing. Finally, I got to see my original opthamologist who removed the plug and prescribed me a combination antibiotic/steroid drop which I used for about 4 days 4x a day. I then went to see him again because all the redness and irritation was gone. However, I am left with a bump under the lower eyelid with what looks like a pore or hole in it. Is this normal? I am not sure what I am seeing. My eyelid does not look the same. I’m not sure if this is residual swelling from what I did or if it’s something that needs to be expressed. I had none of this until the fiasco began with the punctal plug. The bump is skin colored. The hole worries me. I don’t go back again to see him for another 4 weeks. His advice was to do nothing more to it unless I wanted to do compresses which is hard doing with just the lower lid. Can you give me any advice? What do you think the hole is? How long does swelling without infection take to subside? Thanks!

  10. I have had this lump on my lower eyelid for as long as I can remember and it has never bothered me. Is there a reason I should get it checked out.

      • Ophthalmologist or dermatologist for a growth with a white head near tear duct? I know that you cannot give medical advice but I wondered which doctor would be best. We have acdp insurance plan so it will likely be mostly out of pocket. I would like to make sure that the doctor I go to his the best doctor to treat this. Just asking for your recommendation on which specialist you would see first.

  11. Hi… i stumbled on this trying to research.. my 3 year old daughter has had lump under her eye for 4 months. The dr thought sty it didnt go away and got worse changed to angry red to purple to black this morning. The eye dr called it a lesion and said it needs to be surgically removed and biopsied. Its the size of a large pea and does stick out. It is black now and everything im reading is could be cancerous… but i hear google says everything is worse. Realistically could that be what we are seeing?

  12. Hi, I’m 15 years old. I’ve had a ball under my eye for about six months now. It looks exactly like the one in the photo. Up until now it hasn’t bothered me, but recently I’ve been having some discomfort. Do I see a doctor? What could this be? Would I need surgery?

  13. Ive had a bump in my upper lash line for several years. It’s really starting to get larger. I don’t have insurance and money is an issue, so I need to ask if a general practitioner is going to be able to help me, before I make an appointment.

  14. PLEASE DO YOU KNOW ANY GOOD OPTHAMOLOGISTS/Eye surgeons in West Valley/Los Angeles California. I have had over a year of what looks like possible stye but now very large almost dime size! It is a bit ON Lower lid but mainly Inside lid. Thank you!!!

  15. hii ma’am, I had a very little white spot on my upper eyelid I felt nthing but scar only ..BT last few days I feel itching on it..I had Dr advice and appled a cream on it BT no impact .but now I m scared …and much scared from doctor they take too long ..pls advice wht should I do although it does not itching much only 2 or 3 times a day

  16. Hello i have had a lump under my eye for the past 6 Months it was a flesh colour itchy and stings when you touch it but has now gone a dark brown scabby colour and doesn’t itch or sting at all now does it mean it is getting better ? i have been waiting for an appointment for over 2 months and still no letter.

  17. Hi, I am from Nigeria, I ve bums at my outer part left side of my eyes, den d second eye same sport, 2 bums, it looks like growth, its painless but it keeps staying there and its becoming noticeably now, it has been at that sport for 3years now, what can I do to remove it?

  18. I have removed lots of bumps on my eyelids and/or face with small sizzors with no problems. I have one on my lower right eye lid near the waterline. I have clipped part of it off but a bit scared because I do not want to cut the waterline. How about clipping half of it off?? again?? I just do not know how much to clip off before hitting the waterline? I know it sounds crazy, but I have seen many of these bumps clipped off the same way by doctors. I save a lot of money doing it myself, this one seems the same – but scares me because of the cutting.

  19. Had a bunch under upper eyelid. Had surgery in September and went back in November cause it was still open and draining. Had it done again. Went from November to February 8th few weeks ago and had to have it done again . Still draining and open. Had 3 biopsys done and came back normal. My eyelid seems to be drooping now and covering some of my eye. Have to go back on Tuesday to see doctor again. He is stumped why it is not healing. Plans to send me to someone else now. Feeling really frustrated . Any advice!!

    • Hi Bonnie, we don’t give medical advice on the site and because I haven’t seen what your problem looks like, I can’t make a diagnosis. That being said, I strongly urge you to get a second opinion from a specialist in eyelid surgery – either a MOHS surgeon who has worked on eyelids or an ophthalmologist with special training in eyelids. Surgery in that area can be tricky. If your current doctor is “stumped,” you need to see someone else, someone who WILL know what to do…good luck.

  20. Hi Dr.
    I had invasive, ductal, lobular and perineural breast cancer, Dx: March2014. I had all that needed to be done, the usual bilateral mast., chemo and radiation. About 2 months ago I noticed a small bump on my upper eyelid, I tried popping it but nothing came out, a tiny bit of blood is all. It is growing outward and larger, there are no lashes around it., my lashes are still growing back from chemo. I wish I could send a picture. I know what your ans., is going to be, see a Dr. But could it just be maybe the eyelashes because they are trying to grow in. It is not red, itchy or even bothersome. It’s just there and looks like a big pimple sticking out.
    Also,looks like there are very very small ones growing along the lash line as well, not sticking out, whitish in color.

  21. Hey there…I have actually seen my Dr about the lump on my eyelid, and he didn’t seem to concerned. The whole left side of my face was swollen and the lump under my eye is very painful. My eye has been swollen for several days. He did say it did not appear to be a stye. So shouldn’t i get an antibiotic or something?? It feels like the whole ocular bone around my eye is infected or something. He took a swab but said it would take a month to get results back. I’m thinking maybe I should go to ER or something at this point..

    • We do not give medical advice on this site, but I must say, there is something odd about your story. Swabs for bacterial infections do not take a month to get back. If you are not getting better, seeing a different physician or going to the ER may be prudent.

      • Comment:Hey doc…… Am a boy and I am only 17years,I am having a little lump/bump on the lower eyelid of my right eye and it is painless,it started a year ago and I didn’t notice it until people started to ask about it.
        I consulted an eye doctor and she didn’t give me any meds,she said it a chalazion,I must use warm compresses to get rid of it,ofcourse I did and yes it healed,
        but a month later it returned again and it is really comfortable,
        I’ve been using warm compresses ever since it returned,if I skip a day without doing the redeem,it grows slowly.
        The worse my left eye is infected now,I an having a big bun on my upper eyelid and it is painless…when I try to blink I feel like my eye has a bump on it.
        Could it be an eye cancer?
        This thing is really not good,
        people keep on question me about it and I am tired of replying the very same thing everyday!!

  22. I one night got a shower the next morning i awoke and my eye was watery red and i could hardly open it I put vi-zine and it felt better in two days . but at times it bothers me feels like something in it and in that spot on top of the eye lid there a tiny little dot like bump it been about 7 days i going to the Dr this week thank you so very much for this site and being here for us .Many Many Blessing to you . :)

  23. Hi
    I’ve got a tiny reddish lump on my lower waterline,I use mascara and an eye pencil…I’ve had this little lump for over a year at least and it’s not painful or itchy at all,u can only really see it if you look really closely! Any ideas as to what it could be?

  24. Av got a lump on my lower eye lid not sore but was for while tho
    ught a was getting astye but now av got this lump like a pea size?? Wot shud I do ??

  25. Dr. Salber, thank you so much for this information. I had a small bump on my lower lid that was flesh colored for a few months. Just a mole I thought but it started to itch now and then and sting occassionally and started changing to pink. I did not lose eyelashes which is a typical sign of cancer, it looked like a stye. I went to my opthalmologist and he said it looked like an infected folicle but suggested we get it biopsied. I had to travel three hours to an eye hospital and they removed the bump and said they were quite sure it was a benign mole not to worry. I made sure they sent it to pathology for testing and two weeks later got a call it was indeed basal cell carcinoma! They did surgery next day, a pie cut was taken from the lower lid then pulled togethet with many tiny stitches. The procedure is done in the office, it sounds scary and you are not sedated but I experienced no pain at all while it was being done and my surgeon was an angel. The swelling and blackening after surgery is significant, feels like a bruise not terribly painful though just a bit alarming in appearance. the reconstruction was artistically done by Doctor Lee at Baptist Hospital Kendall in Miami and I don’t expect much scarring, he is a very talented eye surgeon. I wanted to thank Dr. Salber for this post, had I not read this, I may have ignored it. Please everyone, if you have something pop up on you lid, don’t wait, see your ophthalmologist immediately and insist on a biopsy even if they tell you its nothing! The procedure is NOT painful don’t worry yourself sick, I promise it is not bad, I have had it done twice last time was yesterday!

      • Doc Pls I’m fifteen and I live in Nigeria last week I saw dis small bump on my eye lid not more than d size of a pimple I’m very worried cos I scared it might be cancer recently I got a lipoma treated and besides I’ll need financial assistance from you to get it treated if it is cancer Pls I need ur reply sooner than later cos I’m very scared right now and I don’t want my parents to get too worried this is my email address in case u are willing to help (phezyphixgnr@gmail.com) thanks God bless

  26. ACK! Now I’m freaked out!!!

    I’ve had a bump on my upper eyelid for 15+ years. Every opthamologist I have been to says it’s nothing.

    I’m nearly in tears cuz I also had a lump in my breast for 2 years. Even though I begged they remove it, no one would (2 diagnostic mammograms and 2 ultrasounds *proved* it was benign)… it was breast cancer. I’m nearly to my one year mark after double mastectomy, lat flap, and chemo. It’s been a year!

    Now this eyelid thingy is REALLY bothering me!

    Last week it kinda increased in size so I made an appointment to have a dermatologist look at it on Monday. Of course, last night it kinda itched, I scratched it, and now it is nearly gone.

    Would it “go away” like that if it were eyelid cancer? (There’s still a teensy bump, but not the larger abscess I’ve had FOR YEARS!!!)

    Basal-cell is not life-threatening?!

    Why won’t these doctors biopsy things when we first complain of them?!?! UGH!

    Thx for your site… I will fight to have it biopsied on Monday (was that painful / difficult cuz of a knife approaching your eye?!)…

    -Shellie

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