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Sebaceous carcinoma (SC) of the eyelid is a rare, aggressive cutaneous malignancy arising from the ocular adnexal sebaceous glands, most notably the meibomian glands and glands of Zeis. Due to its inflammatory and indolent early clinical appearance, it frequently masquerades as benign ocular conditions such as chalazion or chronic blepharitis, leading to significant diagnostic delays. We report a case of a 68-year-old female who presented with a painless, persistent nodule on the right lower eyelid initially treated as a recurrent chalazion. Histopathological assessment revealed a moderately differentiated sebaceous carcinoma. The patient underwent complete surgical clearance via Mohs micrographic surgery (MMS) followed by oculoplastic reconstructive surgery. This case highlights the role of tissue-sparing micrographic surgery in preserving eyelid function and minimizing local recurrence in periocular cutaneous malignancies.

Keywords: Sebaceous Carcinoma, Lower Eyelid, Mohs Micrographic Surgery, Meibomian Gland, Periocular Malignancy