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Protection and Signs of Eyelid Cancer Often Overlooked

Areas of redness may appear gradually and are often overlooked. This patient’s right lower eyelid has a basal cell carcinoma.

The eyelids are among the thinnest, most delicate tissues of the body and are an important part of ocular health. They protect the eyes from foreign bodies and trauma, and help to keep them well lubricated.

Unfortunately, these delicate structures are often overlooked when we think about sun protection. The eyelids are best protected with the use of large sunglasses that block UVA and UVB rays as well as a wide brimmed hat. These protective measures decrease the amount of direct sunlight that reaches the eyelids, and sunglasses offer the added benefit of blocking reflected light. Both are key in reducing the number of ultraviolet rays that reaches this thin, delicate skin and thus reduce the chances of developing skin cancer, particularly in our strong desert sun.

Signs of eyelid cancer are often overlooked as well. A variety of lesions may appear on the eyelids and it is important to distinguish between benign and malignant conditions. Benign lesions include skin tags, seborrheic keratoses, sunspots and nevi (“moles”). Skin tags are not cancerous but can be troublesome cosmetically. These can usually be removed in an in-office procedure if the patient desires. Seborrheic keratoses are waxy and pigmented and have a mounded, wart-like, “stuck on” appearance. They are benign and can also be removed in the office if desired. Sunspots range from benign pigmentation changes to pre-cancerous actinic keratoses. Actinic keratoses are small rough, scaly patches, that are sometimes more palpable than visible.

Very small lesions such as this one on the left cheek may actually represent an early basal cell carcinoma.

Moles by definition are benign. They may be pigmented or non-pigmented. Most remain stable in appearance throughout life, but some may undergo visible change. Change in appearance is a key factor and the ABCDE rule is a useful guide in evaluating this evolution. Important changes to watch for include Asymmetry (one half does not match the appearance of the other half), irregular Borders, non-uniformity of Color, Diameter larger than ¼” (which is about the size of a pencil eraser), and Evolving appearance. A mole that seems to be changing should be evaluated to determine if further treatment is necessary.

Malignant lesions include the many different types of skin cancer that can affect the delicate eyelid tissues. As with the rest of the body, the most common cancer in this area is basal cell carcinoma. Less common types of cancer include squamous cell carcinoma, melanoma and sebaceous cell carcinoma. Important signs of skin cancer include non-healing wounds, crusting and bleeding, loss of eyelashes and/or chronic or progressive erosion or irritation of tissue. Early diagnosis and treatment are key in eyelid malignancies. Appropriate management is important in eradicating the tumor while maintaining as much normal tissue as possible. If skin cancer is diagnosed and is localized to the eyelid, removal is usually indicated. This can be performed by the Oculoplastic surgeon, or by a dermatologist trained in the Mohs technique. Once the cancer is removed, the eyelid must be reconstructed to ensure optimal function and appearance.

This patient has a benign nevus (mole) on the right lower lid which has gradually been increasing in size.

As we’ve described above, eyelid skin is thinner than in other areas of the body and thus more susceptible to sun damage. Your eyelids should be protected from the sun as much as possible. Lesions in this region can be difficult to see and are often overlooked. Any area of concern should be evaluated, preferably by a physician who is specially trained in this eye region.

Dr. Hui is the founder of The Eyelid Institute in Palm Desert. She is an Oculoplastic surgeon and has a special interest in helping patients with Eyelid, Lacrimal and Orbital conditions. An Oculoplastic surgeon is a physician with combined training in Ophthalmic Plastic and Reconstructive Surgery (Oculoplastics) and Ophthalmology who has unique abilities to perform a variety of delicate procedures around the eyes. Dr. Hui can be reached at 760.610.2677.

53 Responses to “Protection and Signs of Eyelid Cancer Often Overlooked”

  1. Chery says:

    My mother had basal cell carcinoma on her eyelid approx 3 yrs ago. Now her other eyelid is swollen & very sore. Can it spread to other eyes? It’s difficult to get her to the doctor/she’s scared & I’m very concerned. Thank you

    • Jennifer Hui, MD, FACS says:

      Dear Chery. Basal cells do not spread from one eyelid to another. If they recur or spread, this will be seen in an area adjacent to the original lesion. However, patients may develop skin cancers at any other sites of the eyelids (new skin cancers). Any concerning lesions should be evaluated. Thank you.

  2. Sam says:

    I have had a mole on the line of my upper eyelid for a while now…like since I was young ( I’m 15)…but is it bad if it is bumpy…I don’t know if it has grown since time or not. Thanks.

    • Jennifer Hui, MD, FACS says:

      Dear Sam,

      Irregular contour is not necessarily indicative of a more serious problem. It is difficult to render an opinion without examining you in person. If you or your parents are concerned, you should be evaluated by a physician. Thank you.

  3. Lou says:

    I have had a mole on my upper eye lid (inside my lashes closest to my eye) for many years now. It has over the course of about 10 years slowly become more of a lump than a flat brown mole (and is a bit unsightly). I have recently noticed a very small flat brown mole on the bottom lower lash line of the same eyelid has appeared.

    I wear contact lenses and have regular eye checks. Is this something I should arrange an appointment with my optitian or GP to check? Or is it nothing to worry about?

    Is this lump on the upper lid something which can be removed? (I think my optitian once said that I could have it removed but it may result in having a gap in my lashes so he didn’t recommend it)

  4. Jennifer Hui, MD, FACS says:

    Hello Lou. If there is a change in the appearance, it should be evaluated. You should see a general ophthalmologist or Oculoplastics specialist (if one is available in your area). Bumps can generally be removed. If lashes are removed with it, they usually regrow. This is case specific however, and your physician can give you a better idea after an examination. Thank you.

  5. Geno says:

    I noticed a little mole on the bottom lining of my eyelid a few weeks ago. I’m concerned, I don’t have insurance to have it taken care… if is a cancerous mole… what kind of treatments would I expect to have?

  6. Jennifer Hui, MD, FACS says:

    Dear Geno. A mole is not necessarily a cancerous lesion. An evaluation is needed first to determine if it has characteristics suspicious enough for biopsy. If so, the lesion can be partially/totally removed in the office and sent to pathology for final determination. If it is a cancer, and the margins are positive, further excision is needed. But again, starting with an exam in the office is the best way to gain more information. Thank you.

  7. Hannah says:

    umm I’m 11 and today I woke up with a mole on my bottom eyelid what is it? :(

  8. Jennifer Hui, MD, FACS says:

    Dear Hannah. It is difficult to say without seeing it in person. Please have one of your parents call for an evaluation and I would happy to help you. Thank you.

  9. Fred says:

    I have had a pimple like lesion on my left eyelid for years – it looks like a small pimple. I noticed today that it is very light in color where before it was much more of a dark pink. No change in size shape or feel. Your thoughts? Thank you.

  10. Jennifer Hui, MD, FACS says:

    Hello Fred. It is difficult to say without personally seeing the lesion. Concerning signs would be non healing surface, bleeding, irregular contour. I recommend that you have an exam with a physician well versed in eyelid conditions to give you the most appropriate advice. Thank you.

  11. Brenda says:

    Hello Dr. Hui,
    I saw my eye Dr. for a lesion on my left lower inner eyelid. He referred me to ocuoplastic surgeon and he is going to biopsy. But not until 8/11. Also sounded like just excising a small piece. Should this be done sooner? The lesion is a small bump that gets a tiny crust and falls off then bleeds. Any advice appreciated.

    • Dr. Hui says:

      Good day Brenda.

      The occasional crusting/bleeding do sound like a biopsy is warranted. I understand that waiting a few weeks may make you nervous. Generally lid lesions do not progress very rapidly, but I cannot give you definite advice without seeing you in person. Perhaps you can try to get an earlier date? Or see another provider if you feel you wish to be sooner. Best of luck.

      • Roo says:

        I got an allergic reaction to an eyelash glue about 5 months ago. Now there is a black line on my eyelid where i applied the lashes. Its itchy and my lashes are still falling off. I also have a bump inside my eye that is itchy. The margin where i applied the glue is still swollen besides trying all kinds of eyedrops and ointments. Is this just an allergic reaction or does the lesion growing inside my eyes have something else to do?

        • Dr. Hui says:

          Without seeing you it is difficult to say. It may be related to the glue allergy. An exam with the appropriate physician would be your next best step.

  12. lauren says:

    Hello Dr. Hui,

    I had a mole on my bottom eye lid on the lash/water line and got it removed in office about 2 years ago. All was fine until a couple days ago when it started to itch and hurt. I have been checking it about once a week since the procedure and am starting to notice a circular dark spot on the inner part of my lower lid as well as a faint brown spot on the outer part of my lower lid, each in the same area where the mole was removed from. Should I be concerned? Is is possible that it could be getting infected somehow now? Or is it possible that it is coming back?

    I’m just not sure what I should do next.

    Thank you so much!

  13. Dr. Hui says:

    Hello Lauren,

    It would be unusual to get an infection so long after the removal. It may be regrowth of the mole, or an irritation that happens to be in the same area. It would be best to have an exam to let your physician take a look and see what is going on.

    Best of luck.

    Dr. Hui

  14. Luke Domanski says:

    Hello Dr. Hui,

    I recently noticed a small mole-like skin formation on my upper eye-lid between my eye-lash line and the eye-ball. It seems to be symmetrical in shape, not bumpy and monochromatic in colour: pale/light brownish. I think that I have had it for a while, but recently noticed that it may have increased in size – it’s currently about 2-3mm in diameter.

    Due to the location of the skin formation (near the eye), I have become quite worried about it.

    Thank You.

  15. Jennifer Hui says:

    Dear Mr. Domanski,

    It is difficult to see without seeing the lesion in person. A mole (nevus) may grow over time. Concerning signs would be loss of lashes or a change in eyelid architecture. An exam would allow for close inspection and evaluation. Thank you.

  16. Razelle Q. says:

    I just recently found a mole brownish black on my lower eye lid. I dont have a mole in that area before and it is very close where my tear duct is. :( is this something i should be bother??? i mean it feels so weird that all of a sudden i have a mole.

    • Dr. Hui says:

      Hello Razelle. Occasionally moles seem to suddenly appear. It is difficult to say without seeing your eyelid. It is a good idea to have a detailed examination of the area to further elucidate the etiology. Thank you.

  17. ILSE says:

    Dear dr. Hui
    My husband developed a mole like lesion on his lower eyelid on hairline. It has bled a few times and lately his eyeball has been going red and sore looking. He says it is not sore. It looks like as if he has got conjunctivitis. The docter has given him a refural but only in September. His eye has flared up again. What to do.

    Thank you

    • Dr. Hui says:

      Good day. It sounds like he needs an evaluation and a biopsy to rule out a skin cancer of the eyelid margin. Pls make sure he follows up with the doctor And emphasize the need for an evaluation. Best of luck.

  18. Lisa says:

    About 1 year ago, I noticed what I thought was a sty on my lower eye lid. It has since grown into a mole with lumps on it. It’s still clear in color but growing in size. Is this something to worry about?

    • Dr. Hui says:

      Good day. An evaluation will determine if it a chalazion (which may need excision) or something else that needs further treatment. Best of luck.

  19. di says:

    Hi a few mths ago i woke up with a lump under my right eye lid now its grown red and sore im scared of needles so i wnt go to the dr ?

  20. Jennifer Hui says:

    Hello. A needle is not necessarily needed. So please see a physician about your concerns.

  21. rosario says:

    Can some one please help me, I just found a green spot on my top right eyelid and I don’t know if I should worry or not. Should I go see a doctor?

  22. Dr. Hui says:

    Hello Rosario,

    An exam would be most helpful to determine the etiology.

  23. Kacie says:

    Hello! I’ve recently noticed a mole almost skin tag type thing on my upper eyelid. Some days it’s more noticeable than others. Isn’t not a dark color but today I noticed a dark like going through it. Could it be cancerous?!

  24. Baily says:

    Hi,
    I got a shower one night and when i woke up my eye was red watery and almost could not open it i put vi-zine in it and that relieved the pain and i felt ok At times i still feel like something is in the eye. There is a little tiny bump on top on my eye lid and that is where i feel like something is in my eye. the lump or bump what ever it is .its almost flat same color as my skin no bleeding or anything just bothers me at times not always but once i notice it i can’t stop worrying.thank you in advance

  25. Jay says:

    Hi Dr. Hui.

    I get eye styes regularly and they usually go away in days. However, a couple years ago, my left eye was bothering me like a stye but more uncomfortable. I checked and saw a black spot in my upper eyelid just beyond the lash line. It’s been bothering me off and on since then and can be quite uncomfortable and make my eye water. What could it be. Thanks.

  26. Kris says:

    Hello-
    I had a basal cell removed two years ago via the Moh’s procedure on my upper lash line and as a result lost a good section of lashes. I was told they will not regrow. Are there any options now for lash implants? Or is permanent makeup (eyeliner) perhaps a better solution? Aesthetically speaking, I really miss my lashes! There is a white gaping section on my lash line now. :(

    • Debra says:

      Hi Kris. I had the same thing three years ago. My eyelid was completely cut off and replaced with skin from elsewhere. After bandage was removed the skin/new lid continued to shrink, so bulging eye and no lashes. Awful. Got it fixed so my eye would close properly, but I will never have lashes again, and the skin is quite thick, so even though better still looked freaky. I got depressed and let myself go.
      I eventually spoke with Chris Gable, the owner of Blinkie’s Cosmetics. They make lashes for ppl who have had cancer and alopcia. My life is changed. My confidence is through the roof and I look better than ever. I am so grateful to look normal again. The lashes (I chose a linerless style) stay on and look completely natural, which is great for me since I do not go for makeup. Check them out. I wish I could show you my before and afters. Good luck!

  27. Dr. Hui says:

    Hello. Unfortunately eyelash transplants are not an option at this time. Daily or permanent makeup may help to mask the difference.

  28. Rachel says:

    I find it funny that everyone comes on here seeking a little advice or help …..and the same advice is given over and over again. People already know they need to see the doctor. They come here to see if anyone else can give advice outside the DR realm…… I was reading the advice one right after the other and same answer everytime people. see your physician for further evaluation……..see your physicican for further evaluation…… don’t waste your time here people. He is not helping you by telling you what you already know.

    • Lauren Del Sarto says:

      Thank you for your comment, Rachel, and for reading Desert Health. All input from readers is appreciated!

      Lauren Del Sarto

  29. Tina says:

    I have a black blob it looks like under my top eyelid on my eye and it constantly makes my eyes feel like I have something in there and its really dry and irritated what is it

  30. Amanda M says:

    I have had this mole on my bottom right eyelid. As a kid they cut it off but it slowly grew back. The last week I noticed it got a little bigger and the top of it looks black or very dark brown. It doesn’t bother me or hurt. But I’m not sure what to do!

  31. Lesley S. says:

    Over recent years I have noticed a dark (black) line forming under the lower lashes of the right eye, but not the left. It looks as if I have drawn black eyeliner under the lashes, but I haven’t. I cannot remove it, and my eye doctor says it’s caused by capillaries. A professional make-up artist told me a few years ago that ‘many women develop this black line as they age…” Really???

    I’m not convinced that I’ve yet discovered the cause. It’s maddening, since I have to add eyeliner under the left eye now to balance it up!

    Can you explain what causes this, and whether there is any way to remove or lessen the effect?

    Many thanks!

  32. Dr. Hui says:

    Good day. This is certainly frustrating for you. It is difficult to render any opinion without seeing the area of concern. Pigment asymmetry may be caused by a variety of conditions, both being and more concerning. The exact color provides clues to depth and origin. An exam with an eyelid specialist would help to begin to differentiate the cause.

  33. Debbie says:

    Hi! I’m 61 and have always had a few “AGE SPOTS” and of course would get darker when I would lay out, as a teenager. After having children I rarely just lay out anymore. I have always used sunscreen as a cream base under my foundation, which I have wore since I was 12. I NEVER go out without at least some foundation and a little blush. I don’t use eye liner or mascara anymore either. Just a eye brow pencil and a little eye shadow. This small size PIN HEAD of a dark spot(light brown, round in shape) right by the eye brow. Over the last 5 years it has gotten bigger, maybe a 1/8 to 1/4” in the same diameter and a light brown. It’s not sore, no bleeding or scabbing, it’s just a growing age spot. I also have one in the back side of my leg above the cafe area, just a round brown circle, but this one is a little whitish in the middle because it’s dry or scaled. No pain, bleeding, ect. Now I have regular age spots but the one on my eyelid just keeps growing a little of the time, where I notice it. I use a good cream for dark circles and discoloration of the skin along with a anti aging cream and some JERGENS CREAM which gives the skin a little color than all white skin. If going out, I apply foundation on the top of my Pur-lisse SPF 30 sunscreen cream ALWAYS. I take pain medication for now my 3rd back surgery, waiting on the 4th. Could something be wrong with my Liver? I do have it checked about every 6 months just to make sure everything’s ok. I’ve not done it yet until July during my yearly physical. What am I dont no wrong. My mom and sister have dark brown age spots all over the face, but their outside, I’m not. Is this normal? I don’t want to go to the doc if it isn’t necessary.
    Thank you so kindly for listening, mostly. Just would like advice. Debbie

    • Lauren Del Sarto says:

      Thank you for reading Desert Health. We have spoke with Dr. Hui and she recommends that you see a physician/dermatologist to determine if this is “normal” or out of the norm.
      With sincere appreciation ~

      Lauren Del Sarto
      Publisher

  34. Ally says:

    I suddenly developed a dark, raised lesion on my lower waterline next to the tear duct. It is also itchy. Should I see a dermatologist or an ophthalmologist? Thank you!

    • Lauren Del Sarto says:

      Thank you, Ally. Either would be able to assist you. Dr. Hui would, of course, be partial to an oththalmologist. Most important to get it checked out.

      With appreciation ~

      Lauren

  35. Iman Nazeer says:

    I have a mole that is right under my eye like right below my lower lash line and I don’t know whether I should see a dermatologist or not.

  36. Marie says:

    I noticed an indention in my lower left water line. Almost like a small chunk had been removed. Ofcourse google wasn’t my best friend. What’s the chances it’s just a rare stye? I’ve made an appointment with my eye doctor for my yearly and planned to have him look at it next week.

    • Lauren Del Sarto says:

      Marie – You are doing the right thing by going to see your doctor as it is hard to determine what it is without seeing it.

      Thank you for reading Desert Health and best of luck with your care ~

      Lauren Del Sarto

    • Kimberly says:

      Marie, the same thing has happened to me about six months ago. I’m 56 woman. I just woke up one day and my daughter asked me if I scratched the inside of my eyelid, I looked in the mirror and yes there was an indentation (almost like a chunk had been taken out) it hasn’t gone away( maybe has gotten a tad bigger, but that could be my imagination) I have no insurance, so I am hesitant to go to the Doctor.

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