By vgreene, 25 June, 2021

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(BMJ)—A man in his 50s had a nonpainful lesion on his R eyelid that had grown from a small nodule over the course of 1 year, after failing to respond to initial tx with PO antibiotics and lid hygiene (for presumed chalazion). The lesion occasionally bled on contact. Exam: nontender eyelid mass. No adenopathy. Bx confirmed dx. What is it?
Chalazion
Merkel cell carcinoma
Lymphoma
Sebaceous cell carcinoma
Hypergranulation
You are correct. Histology after incisional bx confirmed sebaceous cell carcinoma. Distal spread wasn’t evident on imaging or conjunctival map bx. Tx was curative by excisional bx.

A patient should be instructed to return for reevaluation if an eyelid lesion continues to grow, bleeds, or is present for >3 months. Despite a substantial increase in the lesion’s size and because the patient was shielding during the COVID-19 pandemic, he didn’t seek earlier advice.

BMJ 2021;372:n194