Every anatomical structure surrounding the eyes, i.e. skin, hair follicles, and sebaceous glands, is prone to experience abnormal growths within its cellular network. These growths, also known as tumors, may be benign or malignant. Recognizing the difference between a cancerous lesion and a “mole” is a matter of outmost importance, as some malignant tumors around the eyes can cause significant visual impairment, or even death.
Eyelid specialists, known as oculoplastic surgeons, have extensive experience in the diagnosis and treatment of eyelid tumors, whether benign or cancerous. In today’s blog, I will explain the main differences between the two.
How to distinguish between a benign and a malignant mass
Benign lesions of the eyelids represent upwards of 80% of all neoplasms in this area. Most non-cancerous lesions are easy to recognize. However, some masses must be biopsied to rule out malignancy. In general, benign lesions follow well-defined clinical criteria. The following questions can help us to make the correct diagnosis:
Is the lesion chronic, or hast it appeared recently?
A chronic lesion that has been present for decades (since birth or adolescence) most likely represents a benign tumor. It is very uncommon for malignant tumors to be present for many years without causing symptoms, such as pain, irritation, bleeding, etc. Having said that, a benign tumor may experience transformation and become cancerous. This phenomenon is unusual but it must be recognized quickly to prevent irreversible damage to the eye and the tissues that surround it. If you have recently noticed a mass around your eye, it is recommended that you visit your eyelid specialist to rule out a malignant condition.
Has the lesion grown in the last months?
This is the key to a quick diagnosis. A benign lesion will seldom grow significantly, but a malignant tumor will increase in size in a matter of months or years. One of the first questions I ask my patients is this: Is the lesion the same size it was 10 years ago or have you noticed some growth in the last 6 months to a year? If the patient hesitates to answer that question, it means that the tumor has probably grown, and it must be biopsied. A great majority of patients will know if the mass has remained the same size in the last decade. Rapid growth of a mass is not a good sign!
Have you noticed a change in color or texture?
Another important characteristic that should be explored is the color pattern of the mass. This is crucial when trying to rule out very aggressive cancers, such as melanoma. Notice that the color is not as important as the pattern. Let me explain. Not all pigmented tumors are bad; for example, a mole may have a black or blue hue, but the pattern is regular and even. On the other hand, melanomas show an irregular or speckled pattern that spreads out in a web-like arrangement. Color pattern and regularity of the margins of the lesion must be examined by a specialist.
Are eyelashes missing?
Finally, when several eyelashes in or around the mass are missing, there is a high probability of malignancy. Loss of eyelashes is called madarosis. This sign should prompt the patient to seek an immediate evaluation by an eyelid surgeon. The lesion will have to be completely excised and analyzed by a pathologist.
Visual rehabilitation after tumor removal
In some cases, the amount of eyelid tissue that must be removed is quite significant, especially if the mass is cancerous. Nevertheless, oculoplastic surgeons have comprehensive surgical training in the management of eyelid reconstruction after tumor removal. The eyelid specialist considers multiple functional and aesthetic factors at the time of reconstruction to achieve the best result for each patient.
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