This photograph shows a suspicious nevus found on the left cheek, just below the lid, of a 28-year-old male patient. The patient was originally diagnosed with keratoconus and referred for specialty lens fitting. After noting the lesion, a history revealed that the nevus was not new and was without episodic bleeding.

The patient was successfully fit with scleral contact lenses and was referred for a dermatology consult. A biopsy of the lesion showed that it was a benign atypical nevus.

Suspicious lesions discovered on eye examinations should always be carefully evaluated for potential malignancies. A careful history is a key factor for accurate assessment. Remember the ABCDEs of skin cancer detection: Asymmetry, Border, Color, Diameter, and Evolution. If there is doubt concerning malignancy, refer to a dermatologist or ocular plastics physician for further testing and evaluation.