Benign Eyelid Lesions
PAPILLOMA
A papilloma is a common benign, often asymptomatic, skin lesion that occurs most commonly in the intertriginous areas (axillae, inframammary, and groin) but is also commonly seen on the neck and eyelids. Papillomas are often numerous on the eyelids when present, and the number tends to increase with age.
Synonyms: skin tag, acrochordon
Epidemiology and Etiology
• Age: More common in middle-aged and elderly people
• Gender: More common in females
• Etiology: Unknown
History
• Most commonly asymptomatic but may become tender after trauma
• With time, lesions may become crusted or hemorrhagic.
Examination
• Lesions are soft; skin colored, tan, or brown; round or oval, pedunculated papillomas (Fig. 1-1A and B). The lesion is often constricted at the base.
• Size ranges from less than 1 to 10 mm.
Special Considerations
• May grow or become more numerous during pregnancy
• More common in obese patients
Differential Diagnosis
• Pedunculated seborrheic keratosis
• Dermal nevus
• Solitary neurofibroma
• Molluscum contagiosum
• Conjunctival papillomas (Fig. 1-1C) can appear on the eyelid margin but have a different appearance, and the base of the lesion is from the conjunctival surface.
Treatment
• Excision by simply snipping the lesion at the base
Prognosis
• Excellent. Patients may develop other papillomas with time.
 FIGURE 1-1. Papilloma. A. Multiple small papillomas of the upper eyelid. B. Larger papilloma of the right lower eyelid. Conjunctival papilloma. C. Papillomatous lesions may grow from the conjunctival surface and protrude onto the eyelid margin. These papillomas are flesh colored and more friable than cutaneous papillomas. Conjunctival papillomas can be associated with a viral origin. |
SEBORRHEIC KERATOSIS
Seborrheic keratosis is one of the most common benign epithelial tumors. These lesions are hereditary, are rarely seen before the age of 30 years, and will continue to increase over a lifetime. Some patients will only have a few, and others can have hundreds over their body.
Epidemiology and Etiology
• Age: More common as patients age. Rare before age 30 years
• Gender: More common and more extensive in males
• Etiology: Unknown
• Inheritance: Probably autosomal dominant
History
• Lesions are often present for months to years and are often asymptomatic.
• They are most common on the face, trunk, and upper extremities.
Special Considerations
• Most common on lower lids
Differential Diagnosis
• Pigmented actinic keratosis
• Verruca vulgaris
• Pigmented basal cell carcinoma
Pathophysiology
• Epidermal lesion. Benign proliferation of keratinocytes, melanocytes, and formation of horn cysts
Treatment
• Excision of the lesion. Light electrocautery or cryotherapy will permit the lesion to be easily rubbed or curetted off. The underlying base can then be retreated with cautery.
Prognosis
• Excellent with rare recurrence
• Patients will often have many lesions and will develop additional lesions over time.
 FIGURE 1-2. Seborrheic keratosis. A and B. Seborrheic keratosis occurs as common lesions of the eyelids. They tend to get darker as they have been present longer, as seen in B. |
CUTANEOUS HORN
Cutaneous horn is a clinically descriptive term for lesions with exuberant hyperkeratosis. The etiology of this hyperkeratosis can be variable, and biopsy to determine the cause is required.
Epidemiology and Etiology
• Age: Older adults
• Gender: Equal in males and females
• Etiology: Hyperkeratosis is associated with a variety of underlying lesions.
History
• Lesion may grow slowly or rapidly.
Examination
• Raised lesion, often on a stalk, usually white in color
• The surface is hyperkeratotic (Fig. 1-3).
Special Considerations
• Biopsy of these lesions is required to rule out malignant lesion at the base of the lesion, such as basal cell carcinoma or squamous cell carcinoma.
Differential Diagnosis
• This is a descriptive term and not a pathologic, diagnostic term.
• The base of this lesion may be a seborrheic keratosis, verruca vulgaris, basal cell carcinoma, or squamous cell carcinoma
Laboratory Tests
• Pathologic evaluation
Treatment
• Excisional biopsy with pathologic evaluation
EPIDERMAL INCLUSION CYST
Common white to yellow cyst seen around the eyes and elsewhere on the face. Easily treated with excision
Epidemiology and Etiology
• Age: Any
• Gender: Equal in males and females
• Etiology: Arises spontaneously from the infundibulum of the hair follicle or following traumatic implantation of epidermal tissue into the dermis
History
• May have history of trauma to the area
• Lesions usually grow slowly for a period of time and then remain stable.
Examination
• Smooth, round, elevated cyst
• The underlying cyst is white and can often be visualized through the thin eyelid skin (Fig. 1-4).
Special Considerations
• These cysts may become secondarily infected and cause a cellulitis.
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