Peripunctal BCC – Requiring Mohs

Peripunctal BCC - this shows a lump on the lower eyelid just near the peripunctum.
See more before and after photos –

Peripunctal BCC – Requiring Mohs

Just a reminder to look out for lumps and bumps like this Peripunctal BCC – requiring Mohs.

This 50 year old man has a nodular Basal cell carcinoma (BCC) below his left punctum, and I will arrange Mohs surgical excision and oculoplastic reconstruction to clear the tumour and restore aesthesis.

Here is the key:
Always ask the patient if they think there has been a change. Most patients look at their face often, and are very good at picking up change.

Question from an optometrist:

If a patient were to present like this in my chair, how would I tell whether this is ‘cancer’ vs benign tumour. To tell you the truth, when I look at that picture, it doesn’t have your usual tell tale sign of suspicious lesion. And assuming of course, patient never took notice of it.


It is a good question.

I have a rule. If it is obviously benign (you learn over time), I leave it; if it is obviously malignant, I don’t even biopsy; if I am unsure, I biopsy.

If you are unsure, send for a biopsy. The patient is more likely to suffer harm travelling to have a biopsy, or from a misdiagnosis, than from a biopsy itself.

They never tell you what to do when you don’t know, but there is a good saying ….”the tissue is the issue”, so biopsy

Thanks again.

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