Clinicopathological Characteristics of Histopathologically Confirmed Eyelid Lesions: A Retrospective Single-Center Study

Background Eyelid lesions comprise a broad spectrum of benign, malignant, and non-neoplastic conditions originating from various periocular tissues. Because many lesions exhibit overlapping clinical features, distinguishing benign from malignant pathology based solely on clinical examination may be difficult. Histopathological evaluation remains the gold standard for establishing a definitive diagnosis, particularly in recurrent or atypical lesions. This study aimed to evaluate the clinicopathological characteristics of histopathologically confirmed eyelid lesions treated at a tertiary referral ophthalmology center and to identify demographic factors associated with malignant pathology. Methods This retrospective observational study included 161 consecutive patients who underwent surgical excision of eyelid lesions between January 2023 and December 2025 at a tertiary referral center. Only lesions with definitive histopathological diagnoses were included. Demographic characteristics, lesion location, and histopathological findings were analyzed. Histopathological diagnoses were categorized as benign neoplastic, malignant neoplastic, or non-neoplastic inflammatory lesions. Continuous variables were compared using the independent-samples t-test, whereas categorical variables were analyzed using the chi-square or Fisher's exact test. Binary logistic regression analysis was performed to identify independent predictors of malignant pathology. Results A total of 161 patients (88 women and 73 men) with a mean age of 72.6 ± 11.4 years were included. Benign and non-neoplastic lesions accounted for 70.2% of all cases, whereas malignant lesions represented 29.8%. Nevus was the most common benign lesion, while basal cell carcinoma accounted for 87.5% of malignant tumors. Malignant lesions were located predominantly in the lower eyelid (62.5%). Patients with malignant lesions were significantly older than those with benign lesions (p = 0.020). Logistic regression analysis demonstrated increasing age as an independent predictor of malignant pathology (OR 1.05; 95% CI 1.01–1.09; p = 0.018), whereas sex was not significantly associated with malignancy. Conclusions Benign lesions constituted the majority of surgically excised eyelid lesions; however, nearly one-third were malignant. Increasing age and lower eyelid localization were associated with malignant pathology. Routine histopathological examination remains essential for accurate diagnosis, particularly in elderly patients and in recurrent or atypical lesions clinically resembling chalazion.