Mole on the eyelid: risks and removal

A mole on the eyelid is most often a benign melanocytic nevus of the eyelid skin, which forms from melanocytes and can be located on the skin of the eyelid, along the lash line, or in the corner of the eye. Most of these growths are stable, grow slowly, and cause no problems for years. However, in the eyelid area, they are especially sensitive due to their proximity to the cornea, lacrimal ducts, and lash line. Even a harmless nodule can rub the cornea, disrupt eyelash growth, or mimic a malignant tumor. [1]

According to modern observational series, the lion's share of eyelid lesions are benign. Among them, melanocytic nevi are among the three most common diagnoses, second only to soft fibroma and seborrheic keratosis. Malignant and precancerous lesions account for approximately 15% of all eyelid lesions removed, necessitating vigilance, proper examination, and accurate verification. [2]

Given the thin skin of the eyelid, intense sun exposure, and constant mechanical stress, the clinical picture is often blurred: nevi can become pigmented, covered with eyelash hairs, and resemble papillomas, cysts, or basal cell carcinoma. Therefore, today, the standard is a combination of clinical examination with dermatoscopy of the eyelid margin and, if indicated, targeted biopsy. [3]

ICD-10 and ICD-11 codes

In practice, coding is required for both statistics and patient routing. The following codes are used for melanocytic nevi of the eyelid.

Table 1. ICD-10 and ICD-11 codes for melanocytic nevus of the eyelid

Classification	Code	Formulation
ICD-10	D22.1	Melanocytic nevi of the eyelid, including canthus
ICD-10	D22.111, D22.112, D22.121, D22.122	Clarification by side and by upper or lower eyelid
ICD-11	2F20.0	Common acquired melanocytic nevus of the skin
ICD-11	2F20.1	Atypical melanocytic nevus
ICD-11	2F20.2	Congenital melanocytic nevus, including giant variant
ICD-11 expansion of anatomy	XA3RB1; XA9K79; XA53T1; XA0JV9; XA4AX5	Accordingly: eyelids; upper eyelid; edge of the upper eyelid; lower eyelid; edge of the lower eyelid

For ICD-11, post-coordination is used: an expanding anatomy code is added to the core code of the nevus to accurately indicate the location on the eyelid and along the edge of eyelash growth. [4]

Epidemiology

In large clinical and pathological series, up to 85% of removed eyelid lesions are benign. Among benign lesions, soft fibroma, seborrheic keratosis, and melanocytic nevus are the most common. The proportion of nevus in the benign lesions reaches 10%. These figures illustrate the high prevalence of benign conditions, but also highlight that every sixth to seventh removed lesion may be precancerous or malignant. [5]

In other samples, the proportion of nevi among benign eyelid lesions is also significant, ranking second after chalazion or papilloma, reflecting differences in patient referral profiles between ophthalmology and dermatology services. Overall, benign lesions are more common in patients younger than 50–60 years, while malignant lesions predominate in older patients. [6]

Although malignant tumors constitute a minority, the eyelids are the site of approximately 5-10% of all skin malignancies, and the primary histotype is basal cell carcinoma. This is important to consider when monitoring pigmented lesions on the eyelids. [7]

Reasons

Acquired melanocytic nevi are formed from clonal melanocytes that migrate over time from the epidermal-dermal junction into the dermis. In the eyelids, this process is influenced by ultraviolet exposure and microtrauma, which explains the appearance of new lesions in adulthood. Congenital nevi are formed in utero and are detected at birth or in early childhood.

Genetic mechanisms involved in the development of melanocytic nevi include melanocyte proliferation signaling pathways; giant congenital nevi are known to be associated with neurocutaneous melanosis. Although no specific genetic profiles have been identified for eyelid localization, clinically, such nevi are often pigmented and frequently involve eyelash follicles. [9]

Risk factors

Key modifiable factors include unprotected ultraviolet (UV) exposure and chronic eyelid trauma. Non-modifiable factors include fair skin, a family history of multiple nevi, and the presence of a congenital nevus. For eyelid malignancies, risk factors overlap significantly and include older age and cumulative UV exposure. [10]

Pathogenesis

Nevus morphogenesis is traditionally described as a transition from a borderline arrangement of melanocytes to a composite and then intradermal pattern. Intradermal nevi with a soft, dome-shaped relief, sometimes with eyelashes running through them, are often found on the eyelids. Pigmentation can range from light brown to dark. This diversity explains the frequent clinical errors without instrumental visualization. [11]

Symptoms and clinical variants

Most nevi on the eyelids are asymptomatic and are noticed because they are a cosmetic defect. Some patients complain of a foreign body sensation, tearing, or a scratchy feeling, especially if the growth is located along the eyelid margin and changes the direction of eyelash growth. Any signs of rapid growth, bleeding, ulceration, or changes in color or shape require urgent examination. [12]

In children and young adults, congenital and intradermal nevi, often hairy, predominate. Acquired intradermal nevi are more common in adults. During examination, note symmetry, clear borders, uniform color, and the absence of destruction of the ciliary margin. Loss of eyelashes, a "eaten away" eyelid margin, telangiectasias, and pearly ridges are more characteristic of basal cell carcinoma. [13]

Classification, forms and stages

Table 2. Clinical forms of melanocytic nevi on the eyelid

Form	Brief description	Notes for the Century
Border	Flat or slightly raised brown macula	It is less common on the eyelids and requires caution when developing
Composite	Nodule with pigmentation, junction and dermis	May irritate the cornea when placed along the edge of the eyelid
Intradermal	Dome-shaped, often flesh-colored or light brown	The most common type on the eyelids, often with missing eyelashes
Congenital	From birth, often larger, may be hairy	If the size is large, it requires oncovigilance.

A separate category is "split" or "kissing" congenital nevus of the upper and lower eyelids, which forms a single spot when the eyes are closed. The treatment approach for such cases is individualized and depends on the functional and cosmetic goals. [14]

Complications and consequences

For benign nevus, the main risks are not related to degeneration, but to mechanical and cosmetic issues: trichiasis, chronic corneal irritation, reflex lacrimation, and skin maceration. After removal, depigmentation, minor scarring, and changes in eyelash growth are possible, but with gentle techniques, these effects are minimal. The risk of malignant transformation of an eyelid nevus is considered low, but changes in the appearance or atypia require a biopsy. [15]

When to see a doctor

An immediate examination by an ophthalmologist or dermato-oncologist is indicated if any of the following signs are observed: ulceration, bleeding, accelerated growth, color change, eyelid contour distortion, eyelash loss, thickening, or immobility. A "recurring stye" in the same location often turns out to be a tumor—this is also a reason for an urgent consultation. [16]

Table 3. Red flags for moles on the eyelids

Sign	Why is it dangerous?
Loss of eyelashes above the lesion	Indirect marker of hair follicle destruction in tumors
Ulceration, bleeding	Inherent to cancerous lesions of the eyelid
Pearly ridges, telangiectasias	Often seen in basal cell carcinoma
Rapid asymmetry and color change	Suspected atypia
Regular "styes" in one area	It is possible for a tumor to be disguised as inflammation.

[17]

Diagnostics

Step 1. Clinical examination under good lighting. Assessment of location, size, color, symmetry, condition of the ciliary margin, and surrounding skin. Examination with eversion of the eyelid is mandatory, as the true borders of the lesion may be wider than those visible. [18]

Step 2. Dermoscopy of the eyelid margin. On dermatoscopy, a benign intradermal nevus shows uniform brown or flesh-colored structures, sometimes with hairs interspersed within the lesion. Cancer is characterized by ulcerations, abnormal eyelash growth, perpendicular vessels, and pinkish-white structureless zones. [19]

Step 3. Noninvasive microimaging when in doubt. Linear-field confocal optical coherence tomography and other confocal techniques allow for clarification of the lesion architecture before deciding on a biopsy. [20]

Step 4. Histological verification. In the event of any oncologic concern, atypical dynamics, or functional impairment, a targeted biopsy or complete excision with histological examination is indicated. This is the "gold standard" for confirming the nature of the lesion. [21]

Table 4. Diagnostic tools and their role

Method	What does it give?	When needed
Dermatoscopy	Pigment and vascular patterns, signs of benignity	All patients with pigmented lesions of the eyelid
Confocal tomography	Layer architecture, microstructure	In case of questionable dermatoscopy findings
Photo documentation	Objective dynamics over time	When observing stable foci
Histology	Final diagnosis	In case of any concern or decision to remove

[22]

Differential diagnosis

Table 5. How a nevus of the eyelid differs from similar conditions

State	What is similar	What makes it different
Seborrheic keratosis	Pigmented plaque	"Glued" scaly surface, horny cysts
Papilloma	Soft papillary nodule	Lobular surface, flesh-colored, without dermal pigment networks
Apocrine gland cyst	Translucent dome	Bluish tint, without pigment network
Basal cell carcinoma	Pigment, nodule	Pearly ridges, telangiectasias, ulceration, eyelash loss
Squamous cell carcinoma or Bowen's disease	Plaque, crusts	Roughness, progressive infiltration, pain
Sebaceous carcinoma	Edge compaction, "barley"	Persistent "chalazion-like" picture, damage to the meibomian glands

[23]

Treatment

The strategy depends on the clinical presentation, location, and patient preference. For stable, symmetrical, asymptomatic nevi without dermatoscopic signs of atypia, a strategy of observation with photographic documentation every 6-12 months is possible. At the slightest sign of trouble, the strategy is reconsidered. [24]

For functional complaints or cosmetic concerns, gentle surgical techniques are used. For nevi along the eyelid margin, superficial shaving with coagulation is widely used, often with healing by secondary intention. These procedures produce good cosmetic results, a low complication rate, and allow for the collection of material for histology. [25]

If the lesion extends significantly across the eyelid margin or causes significant deformity, wedge resections are used. Modern modifications involving posterior lamellar resection demonstrate high patient satisfaction and minimal disruption of eyelid architecture. The final choice of technique is made by an ophthalmic surgeon with expertise in oculoplastics. [26]

Energy-based techniques such as carbon dioxide laser may be considered for isolated benign lesions, but are not a first-line treatment for pigmented lesions with cancer-associated features, as they do not provide adequate histological material and are associated with the risk of marginal discoloration. If cancer is suspected, marginal excision remains the standard. [27]

Table 6. Choice of tactics

Situation	Preferred solution
Stable, typical nevus without symptoms	Observation with photofixation and dermatoscopy
Symptoms of corneal irritation or eyelash growth disorder	Gentle removal with histology
Atypical signs or active dynamics	Targeted biopsy or complete excision
Suspicion of cancer	Excision with margin control and histology
"Divided" congenital nevus	Individual plan, often staged interventions

[28]

Prevention

The main measures revolve around photoprotection: sunglasses that block ultraviolet rays, careful application of sunscreen around the eyes, and hats with brims. It's important to avoid excessive eyelid rubbing, maintain makeup hygiene, and change makeup regularly. Self-examination and annual checkups with a specialist can help detect early signs of trouble. [29]

Forecast

The prognosis for benign nevi of the eyelid is favorable. Most patients live with these lesions without limitations, and when necessary, minor interventions resolve functional and aesthetic issues. The prognosis for eyelid cancer depends significantly on early detection, so proper triage and timely histology remain the cornerstones of care. [30]

Frequently asked questions

Is it possible to remove a mole on the eyelid with a laser "for beauty's sake"? This can be discussed in individual cases, but at the slightest suspicion of cancer, preference is given to methods that provide a complete histological analysis. [31]

If a mole on the edge of the eyelid is interfering with the cornea and "catching," is it dangerous? The primary risk is irritation of the cornea and disruption of eyelash growth. In this case, gentle removal with histological examination is appropriate. [32]

Is it always necessary to remove congenital moles on the eyelids of children? No. The decision depends on the size, symptoms, and signs of atypia. For large or "split" nevi, staged reconstruction is often chosen. [33]

Coding reference tables

Table 7. ICD-10: details by eyelids

Code	Description
D22.1	Nevi of the eyelid, including canthus
D22.111, D22.112	Right upper and right lower eyelid
D22.121, D22.122	Left upper and left lower eyelid

[34]

Table 8. ICD-11: core codes for cutaneous melanocytic nevi

Code	Description
2F20.0	Common acquired melanocytic nevus
2F20.1	Atypical melanocytic nevus
2F20.2	Congenital melanocytic nevus

[35]

Table 9. ICD-11: expanding localization codes

Code	Localization
XA3RB1	eyelids
XA9K79	Upper eyelid
XA53T1	The edge of the upper eyelid
XA0JV9	Lower eyelid
XA4AX5	The edge of the lower eyelid

[36]