AbstractBackgroundThe clinical differential diagnosis of lesions arising on the eyelid margin may be challenging and an unneeded surgical approach may have serious functional and aesthetic consequences. Nonetheless, early recognition and treatment of malignant tumors of the eyelid margin is mandatory. Line‐field confocal optical coherence tomography (LC‐OCT) is a novel tool for the in vivo, real‐time skin imaging.ObjectivesThe aim of the study was to identify and analyze the LC‐OCT features of a series of eyelid margin growths and to correlate these features with the histopathological findings.MethodsPatients with eyelid margin growths who were scheduled for lesion excision underwent LC‐OCT examination. Inclusion criteria were a challenging clinical aspect of the lesions and a clinical history of recent onset (up to 12 months). In all cases, the histopathological examination of the excised lesions was performed for the final diagnosis.ResultsA total of 31 lesions located on the upper (13 cases) or lower (18 cases) eyelid margin from 28 consecutive patients (male = 15, female = 13; mean age: 64.7 years, range: 44–87 years) were evaluated and excised. The histopathologic diagnoses were nodular basal cell carcinoma (BCC) (nine cases), squamous cell carcinoma (SCC) (three cases), compound nevus (four cases), dermal nevus (two cases), seborrheic keratosis (four cases), pyogenic granuloma (one case), trichilemmal cyst (three cases), and hidrocystoma (five cases). LC‐OCT allowed the in vivo recognition of the main microscopic features of the examined lesions.ConclusionsLC‐OCT represents a promising tool for the evaluation of eyelid margin lesions. Advantages of non‐invasive diagnosis particularly relevant in such a sensitive region include a more correct planning of the treatment and, in case of surgery, the most appropriate surgical approach and, importantly, a correct timing of intervention.