Eyelid and facial lesions (tumours/growths/lumps) are common in patients referred to oculoplastic surgeons. The main goal in the evaluation of these lesions is to differentiate malignant from benign lesions. In general, the majority of malignant tumours affecting the eyelids and surrounding areas are slowly enlarging, destructive lesions that distort or frankly destroy eyelid anatomy. There are a number of subtle features that can help to differentiate malignant from be­nign eyelid tumours. In some cases, however, it can be extremely difficult to make the correct diagnosis of an eyelid lesion without a biopsy (the removal of a sample of tissue which is examined by a pathologist with a microscope). Some malignant lesions may appear to be harmless. Conversely some benign lesions may appear to be sinister. The majority of malignant tumours in this area are basal cell carcinomas (rodent ulcers). Rarer tumours include squamous cell carcinomas, sebaceous gland carcinomas, Merkel cell tumours and melanomas.

Early diagnosis can sig­nificantly reduce morbidity associated with malignant eyelid tumours. However, malignant eyelid tumours are diagnosed early only if a high degree of clinical suspicion is applied when examining all eyelid lesions. The appropriate management of malignant eyelid tumours requires a thorough understanding of their clinical characteristics and their pathologic behaviour. This is what oculoplastic surgeons are trained to do.

Many basal cell carcinomas of the eyelids and surrounding areas are treated with Mohs Micrographic Surgery.

A Basal Cell Carcinoma (Rodent Ulcer) of the Periocular area (malignant)		An eyelid marin naevus (benign)
A Basal Cell Carcinoma (Rodent Ulcer) of the lower eyelid (malignant)

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