What are the hallmark features that would point towards skin cancer vs. a chalazion cyst if you have a bump under the eyelid?

Many people quickly think of cancer when they discover a “bump” somewhere on their body, and beneath the eyelid is no exception.

When skin cancer presents as a bump, it’s likely to be basal cell carcinoma, though other skin cancers (squamous cell carcinoma and melanoma) can be nodular.

However, melanoma of the eyelid usually presents as a dark brown spot that resembles a “bad” mole rather than as a bump.

“Basal cell carcinomas (BCCs) can occur on or near the eyelid margin,” says Nita Patel, MD, Medical Director of Advance Dermatology and Laser Medical Center in Marina Del Rey, CA.

Dr. Patel continues, “They tend to be fixed and firm on palpation [gentle pressing with the fingertips]. BCCs can have a rolled pearly border with telangiectasias.”

Telangiectasias are tiny little spider veins near the surface of the skin.

BCC under the eyelid. You can see the telangiectasias. Credit: Matheson Harris, MD

“Sometimes they can be speckled with pigment,” adds Dr. Patel. “Lesions suspicious for BCCs require a shave biopsy to confirm diagnosis. Surgical excision is the best approach for these lesions.”

Skin Cancer vs. Chalazion Cyst
Under Eyelid

Dr. Patel continues, “This differs from other lesions seen on the eyelid margin such as chalazion cysts. Chalazion cysts are formed due to a blocked Meibomian gland in the upper or lower eyelid margin.

“This can cause inflammation in the surrounding tissues, resulting in redness, swelling, tenderness and sometimes infection.

Chalazion cyst. Note the redness and swelling surrounding the lump. Credit: murdocheye.com

“Chalazion cysts usually resolve over a few days or will improve with the application of warm compresses. Sometimes treatment with antibiotics can help resolve them; however, some can persist requiring surgical removal.”

dr. patelDr. Patel is a diplomate of the American Board of Dermatology and has extensive experience in general dermatology, skin cancer surgery, cosmetic procedures and lasers.