Eyelid
The most common eyelid cancer — its pearly, telangiectatic appearance, and Mohs/excisional treatment with oculoplastic reconstruction.
Medically reviewed by Jon Caster, MDOculoplastic SurgeonLast updated June 2026
Your Surgeon
Jon Caster, MD
🏅 ASOPRS Fellow
Part of our complete guide to Eyelid Skin Tumors — this page covers basal cell carcinoma in depth.
A pearly or waxy nodule with rolled borders and fine surface vessels; some erode into a non-healing ulcer.
Basal cell carcinoma (BCC) is the most common eyelid malignancy, accounting for approximately 90% of all eyelid cancers. It arises from basal keratinocytes of the epidermis and is strongly associated with cumulative UV exposure, fair skin, and immunosuppression. The lower eyelid accounts for ~50% of cases, followed by the medial canthus (~25%), upper eyelid (~15%), and lateral canthus (~10%).
Clinical subtypes:
Have any eyelid lesion evaluated promptly if it:
Lash loss and lid-margin distortion are especially important — they point toward a malignant rather than a benign process.
Surgical management: Mohs micrographic surgery with same-day oculoplastic reconstruction is the gold standard for periocular BCC. Mohs achieves the highest cure rate (5-year recurrence <1% for primary BCC) with the greatest tissue preservation — critical in the eyelid where even a few millimeters matter for function. For nodular BCC of the lower lid not involving the lid margin, wide local excision with frozen-section margin control is an alternative.
BCC is locally destructive but rarely metastasizes (<0.1%). Orbital invasion, though uncommon, can occur with neglected medial canthal BCC and may require orbital exenteration. Hedgehog pathway inhibitors (vismodegib, sonidegib) are used for locally advanced or metastatic BCC not amenable to surgery.
Basal cell carcinoma classically appears as a pearly nodule with rolled borders and fine surface vessels, often with central ulceration and loss of lashes when the lid margin is involved. The lower eyelid and medial canthus are the most common locations.
Schedule a consultation with Jon Caster, MD to learn if this procedure is right for you.
