Treating benign and malignant eyelid lumps

Written by: Mr Daniel Ezra
Published: | Updated: 21/05/2019
Edited by: Bronwen Griffiths

The eyelids are complex structures, made up of several different types of tissue, all of which can become inflamed or swollen, resulting in an eyelid lump. Eyelid lumps are mostly benign, such as sweat gland cysts, xanthelasma, sebaceous cysts or warty growths. These are all easily removed with a local anaesthetic. However, the eyelids can also be a common site for malignant tumours, such as basal cell carcinoma (BCC) and other types of skin cancer. Here we get a description of how a common benign (xanthelasma) and malignant (BCC) eyelid lump are treated by Mr Daniel Ezra, who is a leading ophthalmic surgeon.

What is xanthelasma?

It is a common benign eyelid lump, which presents as a pale discolouration resulting from cholesterol deposits on the inner part of the upper and lower eyelids. These can be removed fairly easily with a local anaesthetic. Xanthelasma lumps are harmless, however, if the appearance of them is bothering the patient, they can choose to have them removed. It is important to note that despite removal, xanthelasma can reoccur.

Xanthelasma results from cholesterol deposits, causing yellowish fatty lumps to develop. They are often caused by having high cholesterol levels and are common in middle-aged or older patients who are frequently female. They can also occur in people with normal cholesterol levels.


Removal of xanthelasma:

The surgical removal of xanthelasma requires local anaesthetic, which is injected into the eyelid to numb them. Eye drops may also be used to help numb the eyelids. Next, the xanthelasma is cut out of the eyelid, closing the incisions with small, dissolvable sutures. Once removed, antibiotic ointment is applied to the eye area, as well as an eye patch. Once you are at home, you will continue to use the ointment as instructed. You can remove the eye patch after a few hours, and it is normal to see some blood or discharge around the treated area. You should rinse this area with cool, sterile water. You can expect some mild discomfort in the first few days, which over-the-counter painkillers will manage. Any bruising or swelling will go down in the weeks following surgery.


What is basal cell carcinoma?

Basal cell carcinoma is the most common form of eyelid cancer, usually presenting as a painless, hard lump on the lower eyelid. This, accompanied with eyelash loss, can be indicative of a malignancy. This lump can grow slowly, destroying deeper tissues. These must be removed surgically as soon as possible after detection. If they are left untreated, the cancer can spread into the orbit, sinuses and brain.


Treatment for eyelid basal cell carcinoma:

The management of malignant eyelid lumps involves surgical removal, followed by surgical reconstruction. However, first of all, a biopsy must be performed to confirm the malignancy. Eyelid tumour removal surgery may be performed by an oculoplastic surgeon, or by a dermatologist, using Mohs technique for sensitive or critical areas. Mohs surgery is performed in several stages where layers of tissue are removed and examined under a microscope for cancerous cells. If cancerous cells are found, the surgeon goes back to that area of the eyelid to remove further layers of tissue, removing the cancer and persevering as much healthy tissue as possible. Once the surgeon confirms removal of the tumour’s cancerous cells, the eyelids are reconstructed. Eyelid reconstruction is highly complex and should only be performed by a specialist oculoplastic surgeon.


If you develop an eyelid lump, make sure you see a specialist about it to confirm whether or not it is malignant and to receive the correct treatment.

By Mr Daniel Ezra

Mr Daniel Ezra is an expert consultant ophthalmic and oculoplastic surgeon based at the prestigious Moorfields Eye Hospital in London, where he is also head of the oculoplastic, orbital and lacrimal research programme. As a leading expert in his field, Mr Ezra specialises in all aspects of lacrimal and eyelid surgery, with particular expertise in functional and aesthetic surgical procedures.

His skills as an oculoplastic surgeon were developed through his advanced subspecialty training at both Moorfields Eye Hospital, and as an Interface Fellow in Cosmetic and Reconstructive Surgery, where he trained in plastic surgery, ENT surgery, oral and maxillofacial surgery, and dermatology. 

His position of Honorary Lecturer at the UCL Institute of Opthalmology reflects his strong interest in education - he frequently lectures both nationally and internationally, and is actively involved in the surgical training of medical students. Mr Ezra regularly speaks at international meetings, and is widely published, with numerous papers and book chapters to his name. 

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