Eyelid lumps, from harmless cysts to skin cancers that need careful surgery.

No. The great majority are benign, including styes, chalazia, papillomas, cysts of Zeis or Moll, xanthelasma and simple naevi. The reason clinicians take eyelid lumps seriously is that a small but important minority are skin cancers, and eyelid skin is thin so early diagnosis matters.

A typical chalazion is a firm, painless lump set back from the lid margin, often after an episode of blepharitis, and it usually settles or responds to a minor procedure. Features that argue against a simple chalazion include growth over months, ulceration, loss of eyelashes, distortion of the lid margin, or recurrence at exactly the same site. Those features need biopsy to exclude sebaceous carcinoma.

Basal cell carcinoma accounts for roughly 90% of eyelid malignancy. It typically appears on the lower lid as a slow-growing, pearly nodule with fine surface vessels (telangiectasia), and may develop a central ulcer. It rarely spreads but destroys local tissue if left, which is why early Mohs surgery is important.

Mohs micrographic surgery removes tumour layer by layer, with each layer checked under the microscope while you wait. It gives the highest cure rate and spares the most healthy tissue, which matters enormously on the eyelid where every millimetre affects blink, tear drainage and appearance. Reconstruction is planned once clear margins are confirmed.

Yes. Xanthelasma is often associated with raised cholesterol or other lipid abnormalities, so a fasting lipid profile and cardiovascular risk assessment are worthwhile even when the plaques themselves are harmless.

A hot, swollen, painful eyelid with fever, reduced eye movements, double vision or loss of vision suggests orbital cellulitis and needs same-day hospital assessment. Rapid growth, spontaneous bleeding, or an ulcerated lump with lash loss also needs urgent specialist review, ideally within two weeks under the suspected-cancer pathway.