An 82-year-old woman has had three recurrent chalazia at the same site on the left lower eyelid over 18 months. The lesion is now firm, yellowish, and has caused loss of the local lash follicles. The MOST important next investigation is:

• A Incision and curettage with routine culture of contents
• B Serum lipid profile and fasting glucose
• C Warm compresses and topical antibiotics for 6 weeks
• D Full-thickness biopsy with histopathology looking for pagetoid spread ✓

Explanation

A recurrent or atypical chalazion in an elderly patient must raise suspicion of sebaceous gland carcinoma, which masquerades as chronic blepharoconjunctivitis or chalazion. Diagnosis needs full-thickness wedge or punch biopsy, because pagetoid spread of tumour cells across the conjunctival epithelium determines whether map biopsies and wider excision are needed. Repeated conservative chalazion treatment delays diagnosis of a potentially metastasising malignancy.

Reference: Yanoff and Duker Ophthalmology, 5th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.