The eyelids are among the most delicate structures of the face, playing a vital role in protecting the eyes, distributing tears, and supporting vision. Because the skin here is thin and exposed to sunlight, it is also particularly vulnerable to certain skin conditions. One such condition is basal cell carcinoma (BCC) – the most common form of skin cancer, which often affects the eyelid region.

Although the term “cancer” may sound alarming, it is important to understand that basal cell carcinoma is usually slow-growing and rarely spreads to other parts of the body. However, when it develops around the eyes, early diagnosis and appropriate management are essential to preserve both eye health and appearance.

What Is Basal Cell Carcinoma?

Basal cell carcinoma is a type of skin cancer that arises from the basal cells – small, round cells located in the lower part of the epidermis (outer skin layer). Prolonged exposure to ultraviolet (UV) radiation from the sun is the leading cause, although genetic factors and fair skin may increase the risk.

When it occurs on the eyelids, basal cell carcinoma can be particularly concerning, as the tumour may gradually damage the eyelid tissues, lashes, and sometimes even extend deeper if left untreated.

How Common Is It on the Eyelids?

Basal cell carcinoma is the most common eyelid malignancy, accounting for nearly 80–90% of all eyelid cancers. The lower eyelid is the most frequently affected site, followed by the inner corner (medial canthus), upper eyelid, and outer corner.

Signs and Symptoms to Watch For

Because BCC tends to grow slowly, it may initially look like a harmless bump. Over time, however, certain features can help distinguish it. You should be alert if you notice:

• A persistent lump or bump on the eyelid that does not heal
• A shiny, pearly, or translucent nodule
• An ulcer or sore that bleeds, crusts, or recurs
• Loss of eyelashes near the affected area
• Thickening or distortion of the eyelid margin
• Redness or irritation that persists

It is important not to ignore these signs, as early intervention can prevent more extensive surgery later.

Risk Factors

Several factors can increase the chances of developing basal cell carcinoma of the eyelid:

• Excessive sun exposure without protective measures
• Fair skin that burns easily
• Older age, as cumulative sun damage adds up
• History of previous skin cancers
• Genetic conditions such as basal cell naevus syndrome (rare)

Wearing sunglasses, using sunscreen, and avoiding direct sun exposure during peak hours can significantly reduce the risk.

Diagnosis

If a suspicious lesion is noticed, an ophthalmologist or oculoplasty surgeon will carefully examine the eyelid. In many cases, a small biopsy is performed – a sample of the tissue is taken and examined under a microscope to confirm the diagnosis. Imaging tests may also be recommended if there is suspicion of deeper spread.

Treatment Options

The goal of treatment is not only to completely remove the cancer but also to preserve eyelid function and achieve the best cosmetic outcome. Treatment is individualised, depending on the size, location, and depth of the tumour.

Some of the commonly used treatment approaches include:

• Surgical Removal (Excision): The most common and effective treatment, where the tumour is removed with a margin of healthy tissue. In delicate areas like the eyelid, special techniques ensure minimal tissue loss.
• Mohs Micrographic Surgery: A precise method where the tumour is removed layer by layer and examined under a microscope until no cancer cells remain. This helps conserve healthy tissue.
• Reconstructive Surgery: After tumour removal, eyelid reconstruction may be necessary to restore both function and appearance. Oculoplastic surgeons are trained in advanced techniques for this.
• Other Therapies: In selected cases, radiation therapy or topical treatments may be considered.

Importance of Early Detection

One of the most reassuring aspects of basal cell carcinoma is that it rarely spreads to distant parts of the body. However, if neglected, it can become locally destructive, invading surrounding tissues, the nose, or even the orbit. Early detection ensures that treatment is simpler, less invasive, and cosmetically favourable.

When Should You See a Specialist?

You should consult a specialist if you notice:

• Any new or unusual growth on your eyelid
• A lesion that does not heal within a few weeks
• Changes in the shape or appearance of the eyelid margin
• Loss of eyelashes or distortion of eyelid structure

An oculoplasty surgeon is specially trained to manage such conditions with a balance of medical safety and aesthetic considerations.

Conclusion

Basal cell carcinoma of the eyelid is common but highly treatable, especially when detected early. Awareness of its signs, timely medical attention, and appropriate treatment are the keys to preserving vision and maintaining eyelid function.

If you are concerned about any suspicious eyelid lesion or have been advised to undergo treatment, it is essential to consult a specialist with expertise in eyelid and orbital surgery.

For compassionate care and advanced management of eyelid tumours, you may consider consulting Dr. Saurbhi Khurana, Oculoplasty Surgeon. With her specialised training and experience, she ensures that treatment is tailored to achieve both medical safety and natural appearance.