Oncology Case Challenge: A Construction Worker Who Drinks Daily Has an Eyelid Lesion

Nail Alouch, MD; Doina Ivan, MD; Phyu P. Aung, MD, PhD; Victor G. Prieto, MD, PhD


November 02, 2022

Editor's Note:
The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case that you would like to suggest for a future Case Challenge, please contact us.


A 76-year-old man with a medical history of multiple cutaneous basal cell carcinomas presents with a lesion on his right lateral lower eyelid. The lesion was noted by an optometrist approximately 8 months ago, during a routine eye examination. It appeared to be slow-growing. The clinical impression was basal cell carcinoma. The lesion was biopsied at an outside facility, and the patient was referred for further workup.

His medical history includes hypertension; multiple basal cell carcinomas of the face, trunk, and extremities; prostate cancer (prostatectomy and radiation therapy about 13 years ago); removal of a synovial cyst on the lower spine; cervical disk surgery; and hernia repair. The patient takes aspirin (81 mg daily) and lisinopril (5 mg daily). He has no known drug allergies. His family history is noncontributory.

The patient works in construction. He smoked one pack of cigarettes per day for about 23 years and has recently reduced this to smoking six or seven cigarettes per day. He consumes approximately two alcoholic drinks per day and has no history of illicit drug use.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.