Small growth in meibomian area of lower eyelid

[alwaysaquestion]

I will preface this by saying I have already seen an ophthalmologist and, although I personally liked him and he has excellent credentials, I'm not comfortable with his preliminary diagnosis nor how long from now he's recommending a follow-up visit.

As background, I'm a 62 y.o. male, have had blepharitis for 40 years, and also have several nevi on and in my left eye (i.e., corner margin of lower lid, on the sclera, and in the retina). I would assume this suggests significant sun exposure, likely due to driving. These nevi have been extensively and regularly evaluated.

About three weeks ago, I noticed an indent in the lower lid of my left eye right up against my eyeball. The indent was slightly red, I'm guessing because it's exposing a thin line of the darker mucosa on the inside of the lid. Within days, a small papule appeared -- pale pink/white, maybe a little yellow/grey -- starting in an eyelash and moving up to the eyeball in a teardrop shape. It's small, exactly 1 mm in width and probably a bit longer as the top point of the teardrop extends to the eye. It appears a bit embedded, but the part by the eyelashes is raised a bit. I may not have noticed it if not for a 10x mirror, although it's embedded nature caught the light in way that created a small shadow that I could see in a regular mirror.

My new ophthalmologist (my previous doc left my plan) examined it with a slit lamp and said it looks like a stye that never fully formed. Although I normally clean and use warm compresses for my blepharitis, he told me to be more aggressive -- 4X-a-day cleaning with baby shampoo and 5-minute warm compresses. He said we'll revisit in 3 WEEKS. He intimated that the next step would be antibiotics.

At the time of this appointment, the papule had already been visible for two weeks. For an entire week now, I've been cleaning the lids and using warm compresses for 10 MINUTES 4X per day. So it's now been three weeks total without any healing.

My question is: In your own practice, would you follow a similar plan? I'm concerned that it could be cancer, especially the more concerning sebaceous carcinoma (SC), that I understand is known as "The Great Masquerader" and is often confused with styes and chalazia. I'm sure my doc wants to spare me an unnecessary biopsy, but I'm very uncomfortable waiting another month or more to have a definitive answer when the preliminary treatment appears to be ineffective and the lesion checks many of the SC boxes.

My apologies for the long post. I've tried to incorporate as many details as possible. Thanks as always. You've been exceptionally helpful with an earlier question, and I look forward to your reply.

[John C Hagan III, MD, FACS, FAAO]

This one of those questions that do not lend themselves to webpaage discussion.  Examing the involved area with high magnification, using a moist Qtip to see if it is moveable vs fixed are essential. Why not call the new doctor, express your concerns and return earlier? That's about all I can say.

[alwaysaquestion]

Thanks, Dr. Hagen. I did plan to do that, but was trying to assess whether my concerns had any basis or if this doctor’s plan is standard procedure in such cases. I’m unsure whether he checked for the papule’s movability, so that’s a detail I can ask about. I assume that if it’s movable, it’s good and fixed is bad.

[John C Hagan III, MD, FACS, FAAO]

Movable is good, fixed is bad. There is no 'standard' procedure for dealing with something like this. That is about as far out on the limb as I can go