Some eyelid lesions can be identified by their history and clinical appearance, and then treated appropriately. However, many benign lesions can be confused with more aggressive malignant tumors from which they must be differentiated. When doubt exists as to a specific diagnosis, a biopsy should be obtained and submitted for histopathologic evaluation. Based on the findings a more directed therapeutic approach can then be planned. In some cases such as inflammatory lesions medical therapy alone might be indicated. But for malignant and premalignant neoplasms or for benign lesions that are of cosmetic or functional concern further surgery is often necessary.