Differential Diagnosis for a 74-year-old Male with a Black Eye and No Trauma

• Single most likely diagnosis:
  • Basal cell carcinoma or other skin cancers: A black eye without trauma in an elderly individual could be indicative of a skin cancer, such as basal cell carcinoma, which can cause pigmentation changes and lesions that might resemble a bruise.
• Other Likely diagnoses:
  • Melanoma: Similar to basal cell carcinoma, melanoma can cause pigmentation changes and could be considered, especially given the age and presentation.
  • Diabetic retinopathy or other vascular issues: Although less directly related to the appearance of a black eye, vascular issues could potentially lead to hemorrhages that might be visible under the skin.
  • Age-related pigmentation changes: As people age, they can experience changes in skin pigmentation that might appear as dark spots or areas, potentially mistaken for a black eye.
• Do Not Miss diagnoses:
  • Orbital or periorbital cellulitis: An infection in the tissues surrounding the eye, which could be life-threatening if not treated promptly.
  • Cavernous sinus thrombosis: A rare but potentially deadly condition that could result from facial infections, including those around the eye.
  • Hematoma from a bleeding disorder: Although the patient reports no trauma, a spontaneous hematoma could occur in someone with a bleeding disorder, which would be critical to identify and treat.
• Rare diagnoses:
  • Chalazion or hordeolum (stye): While typically associated with a lump or swelling, in rare cases, these conditions could cause discoloration.
  • Sarcoidosis: A condition that can cause skin lesions and pigmentation changes, among other symptoms, and could potentially be mistaken for a black eye.
  • Amyloidosis: A group of diseases that can cause changes in skin pigmentation, among many other symptoms, and could be considered in a differential diagnosis for unexplained skin changes.