An eyelid lump that won't go away: could it be eyelid cancer, and who treats it in Malaysia?

Most eyelid lumps are harmless, but one that has lasted more than a few weeks, bleeds, or takes away lashes should be examined and, if needed, biopsied. Dr Catherine Chow, oculoplastic surgeon, explains which lumps are watched, which are removed, and which doctors treat eyelid cancer in Malaysia: oculoplastic surgeons for removal and reconstruction, with dermatology and Mohs surgery in some cases, and oncology if the cancer has spread.

I have an eyelid lump that won't go away. Could it be eyelid cancer, and who treats it in Malaysia?

It could be, but it is far more often something benign, and only an examination, sometimes with a biopsy, can tell the two apart. A biopsy means a small piece of the lump, or all of it, is removed and examined under a microscope. In Malaysia an eyelid cancer is treated mainly by an oculoplastic surgeon, an eye doctor trained in eyelid surgery and rebuilding, working with a pathologist and sometimes a dermatologist or a cancer specialist.

The numbers help to keep this in proportion. A five-year review of 136 eyelid tumours biopsied at Hospital Sultanah Bahiyah in Alor Setar found that 114 (83.8%) were benign and 22 (16.2%) were malignant. So a lump that will not go away is usually not cancer. But a lump that will not go away is also a useful warning sign, because benign lumps usually change, settle or declare themselves, while a cancer tends to stay and slowly grow.

Which eyelid lumps are usually harmless?

The common ones are a chalazion, a stye, a cyst, a skin tag or a wart-like papilloma. A chalazion is the medical name for a blocked oil gland in the lid, which forms a firm, usually painless bump. My guide to chalazion sets out how to tell it from a stye, which is a sore, infected bump at the lash line, and the article on styes explains how long one should take to settle.

Skin growths have their own page. The article on lumps that are not a stye covers skin tags, seborrhoeic keratosis (a waxy, stuck-on benign growth) and papilloma. The Malaysian biopsy review lists what was actually found in the benign group: dermoid cyst in 22.8% of all tumours biopsied, melanocytic naevus (a mole) in 14%, granuloma in 12.5%, squamous cell papilloma in 9.6% and epidermal cyst in 8.8%. A dermoid cyst, a lump present from childhood, had the youngest average age, 17 years.

What these have in common is behaviour. They stay put, keep their shape, and leave the lashes and the lid margin alone. A chalazion that clears with warm compresses, or a stye that comes to a head and drains, is behaving as expected.

What are the warning signs that a lump may be eyelid cancer?

The signs that change the question are a pearly or waxy edge with tiny visible blood vessels, lashes lost over the lump, a sore that bleeds, crusts or will not heal, and a lump that is slowly growing or distorting the lid. Time matters too. The NHS advice on non-melanoma skin cancer is to see a doctor about any skin growth that is getting bigger, changing colour or texture, or that hurts, itches, bleeds, crusts or scabs for more than 4 weeks.

Basal cell carcinoma, a slow-growing skin cancer, is the usual eyelid cancer and typically looks like a small pearly bump rather than an angry sore. I describe the full list in my article on eyelid skin cancer warning signs.

The one that deserves a particular warning is sebaceous carcinoma, a rare cancer of the oil glands of the lid. It imitates a chalazion that keeps coming back in the same place. A UK study that followed 51 patients with newly diagnosed ocular sebaceous carcinoma found that the most common wrong diagnoses were chalazion (42%), basal cell carcinoma (30%) and blepharoconjunctivitis, inflammation of the lid and eye surface (16%). The median delay before the right diagnosis was 10 months, and the authors reported that a missed chalazion diagnosis was linked to a longer delay and to spread within the surface layer of the tissue. The cancer is rare, with an estimated UK incidence of 0.41 cases per million people a year, but the lesson is a practical one: a chalazion that returns in the same spot, or one in later life (the median age in that series was 70), is a reason to ask for the tissue to be examined.

What do Malaysian data show about eyelid tumours?

They show that most eyelid tumours are benign, that the malignant ones favour the lower lid, and that basal cell carcinoma is the commonest eyelid cancer. The review in the Cureus journal looked at every eyelid tumour biopsied between January 2016 and December 2020 at Hospital Sultanah Bahiyah, which the paper describes as the tertiary referral centre of oculoplastic service in northern Malaysia.

Of the 136 tumours, 93 (68.4%) were on the upper lid and 41 (30.1%) on the lower lid, but this was driven by the benign group, whose tumours sat mostly on the upper lid. Among the malignant tumours the pattern reversed: 81.8% were on the lower lid. That is why a lump on the lower lid that persists deserves a little more attention. Two sebaceous carcinomas were found, and one of those patients had spread to nearby lymph nodes and the chest wall, which shows why the rare cases matter.

A caution about reading these figures. They describe lumps that were biopsied at one referral hospital, not every lump in the community, so they cannot give a personal risk. The abstract and the tables of the paper also differ on the exact count of basal cell carcinoma, so I do not quote one. I discuss how these cancers are removed in the article on basal cell carcinoma, Mohs surgery and reconstruction.

How is an eyelid lump diagnosed?

By a careful look at the lump, the lashes and the lid margin, followed by a biopsy when the picture is not clearly benign. A surgeon checks whether the lump is fixed or movable, whether the lash line is intact, and whether there are visible vessels. The biopsy then gives the answer, because appearance alone can mislead, as the sebaceous carcinoma figures above show.

In the Malaysian review the diagnosis was made on tissue taken by excisional biopsy (the whole lump removed) or incisional biopsy (a piece removed). The choice depends on size and position, since the lid is a small structure and every millimetre counts for how well it closes afterwards. Having the specimen examined by a pathologist is not an overreaction. It is the step that turns a guess into a diagnosis, and it is routine for any lump that has an unusual story.

Who treats eyelid cancer in Malaysia?

Oculoplastic surgeons usually take the lead, because the task is twofold: remove the cancer with a clear margin, then rebuild a lid that still closes and protects the eye. An oculoplastic department's series in Tunisia, covering 123 patients with malignant eyelid tumours found safety margins of 4 mm in 63.2% of lesions and 5 to 6 mm in 34.2%, with the front layer of the lid rebuilt in 80.7% and the inner lining in 57.9%. Recurrence occurred in 6.1% after an average of 36 months, and the authors concluded that the outlook depends on the quality of the surgery. These are one hospital's figures, not a promise for anyone else.

Other specialists have a place. A dermatologist may be involved for skin cancers, and Mohs surgery, a technique that examines the edges of the removed tissue under the microscope in stages, is used in some cases. In the UK sebaceous carcinoma series, Mohs surgery was the primary treatment in 8% of cases, while excision with reconstruction was used in 49%. An oncologist joins the team if a cancer is large, has spread, or needs radiotherapy or drug treatment. In very large tumours that reach the eye socket, a head and neck surgical team may join the eye surgeon. To understand what the specialty covers, read what an oculoplastic surgeon is and when to see one.

Dr Catherine Chow begins consulting at Eagle Eye Centre Malaysia, Petaling Jaya, from early 2027. This article is general education and cannot say what any particular lump is.

What should I do this week about an eyelid lump?

Get it examined by a doctor, and take a photograph today so that change can be judged later. Put a ruler or a coin beside the lump, use the same light, and note the date. The photograph will tell the examiner more than your memory will after a month.

• Do not squeeze, pick or lance the lump, and do not apply creams to it.
• Book an eye doctor or GP visit if it has lasted more than 4 weeks, has bled, or lashes in that area have gone.
• Go sooner if it is growing quickly, has an open sore, or the lid is changing shape.
• Bring the dates: when it began, whether it has come back after treatment, and how it has changed.

Most visits end in reassurance or a simple removal. For a wider look at the area, see the eyelid conditions section, and the hub article on why eyes look tired explains how lids that look tired are separated from lids that are unwell.