Welcome to question of the day #287

Welcome to question of the day #287

I have just examined a patient who is new to my practice. He was complaining of a lump on his lower right eyelid margin. He told me that it would often bleed, scab over, and then bleed again. He had had it for around two years and had been told by another eye specialist that it was a stye, nothing to worry about and he should use artificial tear drops. This doesn’t sound like a stye to me. What should I do?

This is definitely not a stye. It bleeds and has been reoccurring for a long time. It is likely to be a basal cell carcinoma or a squamous cell carcinoma.

Basal cell carcinoma usually appears as a small, shiny pink or pearly-white lump with a translucent or waxy appearance. It can also look like a red, scaly patch. Sometimes there is brown or black pigment within the patch.

The lump slowly gets bigger and may become crusty, bleed or develop into a painless ulcer. Basal cell carcinoma does not usually spread to other parts of the body but when it occurs on the lid margin it can destroy the skin structures here. Also, the bigger it is the more skin needs to be removed with surgery if that is part of the treatment. This can disfigure the eye. The earlier it is treated the smaller it will be and less skin will need to be removed.

Squamous cell carcinoma appears as a firm pink lump with a rough or crusted surface. There can be a lot of surface scale and sometimes a spiky horn sticking up from the surface. The lump often feels tender when touched, bleeds easily, and may develop into an ulcer.

There’s a small risk (up to 5%) of squamous cell carcinoma spreading to other parts of the body, usually the lymph nodes (small glands found throughout your body).

Your patient needs to be examined by a dermatologist. The sooner the better.