The correct answer is D.
This patient’s presentation is most suggestive of basal cell carcinoma (BCC). BCC is the most common eyelid malignancy. Exposure to the sun and a history of previous cancers can increase the risk for a patient to develop BCC. It is commonly present as a non-healing, ulcerated lesion with pearly, rolled borders and telangiectasia. Madarosis, or the loss of eyelashes, can also be present, as seen in this patient. A biopsy is needed to determine the pathology of the lesion. Treatment is with complete surgical excision, which may include Mohs surgery. Patients may require oculoplastic reconstruction afterwards, depending on the extent of the excision. Close monitoring is recommended for possible recurrence.
Warm compresses and massage (Choice A) is the treatment for a hordeolum, or a stye, and will not resolve a BCC lesion. Incision and drainage (Choice B) can be recommended for a persistent or severe chalazion, but will not remove a BCC lesion. Steroid injections (Choice C) may be used to manage complications or scars that may arise from the surgery, but will not treat the BCC itself. Antibiotic therapy (Choice E) can be used for persistent or severe styes. It can also prevent infection post-surgery, but not for treatment.
Source: O'Malley EM, Nerad JA, Syed NA. Nodular Basal Cell Carcinoma: 49-year-old female with left lower lid lesion. EyeRounds.org. August 24, 2005; Available from: http://www.EyeRounds.org/cases/44-Nodular-Basal-Cell-Carcinoma-BCC.htm.
