A 37-year-old woman presents with a chief complaint that her eyelid is disintegrating. She states that the edge of her left lower eyelid has been intermittently irritated and itchy over the past 2 years. She has noticed loss of eyelashes in the area and an occasional scab. She denies any growths or styes. Her past ocular history is unremarkable. Examination shows uncorrected visual acuity of 20/20 OD and 20/25-1 OS. Anterior and posterior segment exams are normal. The left lower eyelid appearance is shown below:
Describe the Abnormality:
Ulceration and lash loss of the lateral half of the eyelid margin. The borders have a pearly, irregular, nodular appearance.
What is the Differential Diagnosis of This Lesion?
The lesion is highly suspicious for a malignant eyelid tumor. The most likely diagnosis is basal cell carcinoma (BCC) followed by squamous cell carcinoma. In an older individual, sebaceous cell carcinoma is another possibility.
How Would You Manage this Patient?
Explain to the patient that the appearance of her eyelid is suspicious for a skin cancer and a biopsy is necessary to make a definitive diagnosis.
Additional Information:
The patient had a biopsy and the pathology report was positive for nodular basal cell carcinoma.
What Are the Etiology, Treatment and Prognosis for BCC?
BCC is the most common eyelid malignancy. BCC of the eyelid usually occurs in older adults and is most commonly found in the lower lid. BCC is associated with UV (sun) exposure, fair skin, older age and smoking. The most common growth pattern is nodular, which is less invasive than the morpheaform variety. Treatment is complete surgical excision with frozen section, and some lesions may require supplemental cryotherapy or radiation therapy. It is locally invasive but rarely metastatic.