Metachronous Eyelid Basal Cell Carcinoma on Opposite Eye and Lid: A Case Report

Background: Basal cell carcinoma (BCC) is the most common eyelid malignancy, accounting for approximately 90% of malignant eyelid lesions.1 Despite its high occurrence rates, it is frequently misdiagnosed as one of the benign “lumps and bumps” that can be present on the eyelid. In the present case, a patient with a past BCC on the right upper eyelid presented with a left lower eyelid lesion which persisted for months before the patient sought evaluation by an eyecare provider. This benign-looking lash-line lesion was the only external sign of the malignancy found on the deep surface of the eyelid and later diagnosed as BCC. Case Report: A 74-year-old patient presented with a persistent eyelid lesion that was resistant to treatment for greater than 6 months. The small lesion was slightly suspicious in appearance. Further evaluation revealed a larger, more irregular lesion on the conjunctival surface of the eyelid. The patient was referred to an oculoplastic specialist for biopsy. Pathology confirmed the diagnosis of basal cell carcinoma. Conclusion: Once the lesion was properly diagnosed, the patient underwent Mohs micrographic surgery and eyelid reconstruction. This case will highlight the importance of prompt and thorough evaluation of suspicious eyelid lesions which are persistent and resistant to treatment in patients with a history of eyelid malignancy.