A Little Lump Or Bump On The Eyelid? Beware, It Could Be Skin Cancer!

By Patricia Salber, MD, MBA | Published 4/22/2020 54

lump bump eyelid basal cell carcinoma

Lumps or bumps on the eyelid can sometimes turn out to be cancerous.Photo source: Stockvault)

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 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.

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 non-melanoma 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.

**Love our content? SIGN UP FOR OUR NEWSLETTER HERE**

Patricia Salber, MD, MBA

Website: https://thedoctorweighsin.com

Patricia Salber, MD, MBA is the Founder. CEO, and Editor-in-Chief of The Doctor Weighs In (TDWI). Founded in 2005 as a single-author blog, it has evolved into a multi-authored, multi-media health information site with a global audience. She has worked hard to ensure that TDWI is a trusted resource for health information on a wide variety of health topics. Moreover, Dr. Salber is widely acknowledged as an important contributor to the health information space, including having been honored by LinkedIn as one of ten Top Voices in Healthcare in both 2017 and 2018.

Dr. Salber has a long list of peer-reviewed publications as well as publications in trade and popular press. She has published two books, the latest being “Connected Health: Improving Care, Safety, and Efficiency with Wearables and IoT solutions. She has hosted podcasts and video interviews with many well-known healthcare experts and innovators. Spreading the word about health and healthcare innovation is her passion.

She attended the University of California Berkeley for her undergraduate and graduate studies and UC 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. And, also served as the lead on a dedicated Kaiser Permanente-General Motors team to help GM with its managed care strategy. GM was the largest private purchaser of healthcare in the world at that time. After leaving KP, she worked as a physician executive in a number of health plans, including serving as EVP and Chief Medical Officer at Universal American.

She consults and/or advises a wide variety of organizations including digital start-ups such as CliniOps, My Safety Nest, and Doctor Base (acquired). 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 chairs the organization’s Development Committee and she also chairs MedShare's Western Regional Council.

Dr. Salber is married and lives with her husband and dog in beautiful Marin County in California. She has three grown children and two granddaughters with whom she loves to travel.

Comments:

  • 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.

  • 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?

  • 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.

  • 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.

  • 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.

  • 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!!

Leave a Reply

Your email address will not be published. Required fields are marked *

This site uses Akismet to reduce spam. Learn how your comment data is processed.

Comment will held for moderation