Management of Benign Eyelid Lesions
Betsy Colón-Acevedo, MD
DISEASE DESCRIPTION
Periocular skin lesions are extremely common. Screening for them should be a routine component of the eye examination. No single clinical feature or growth pattern predicts malignancy of a lesion with 100% accuracy. We send all sampled lesions (incisional or excisional biopsies) for histopathologic review.
Generally, eyelid lesions smaller than 4 to 5 mm may be excised and left to heal by secondary intention. Larger lesions may require simple or layered closure, directing wound tension horizontally to avoid vertical eyelid retraction. If a pericanalicular or peripunctal lesion requires extensive dissection, protect the canaliculus with a monocanalicular stent.
BENIGN EPIDERMAL TUMORS
Acrochordon (also called fibroepithelioma, papilloma, skin tag)
May arise anywhere on the skin of the face. But on the lid, they are usually small 2 to 3 mm flesh-colored pedunculated lesions.
More common in female and elderly patients
Management
Excision at the base
Prognosis
Excellent for excised lesions
Nearby recurrence is possible, especially for patients with multiple lesions.
Seborrheic keratosis (Figure 15.1)
Superficial, develops in hair-bearing areas of skin.
Appears as minimally elevated, hyperpigmented, tan-to-brown plaque with a “stuck-on” appearance
Most common on the lower eyelid
More common in males and rare before age 30
FIGURE 15.1. Seborrheic keratosis presenting as a brown plaque with a “stuck-on” appearance at the medial canthus.
Management
Because they are epithelial, can be removed by a shave biopsy, leaving the deep layers of the skin intact.
Cryotherapy
Prognosis
Excellent for excised lesions
Within the lash line, lash loss and lesion recurrence due to incomplete excision are common.
Cutaneous horn
“Horn-like” curved, hard projection arising from the surface of the skin
Composed of a collection of keratin
May be associated with underlying cutaneous malignancy
Management
Excisional biopsy, including the base of the lesion to determine the definitive diagnosis
Prognosis
Excellent, assuming there is no malignancy at the base.
Epidermal inclusion cyst (Figure 15.2)
Round, elevated cysts usually measuring 1 to 6 mm, often with an associated pore
Arise in association with a hair follicle
Contains keratin
FIGURE 15.2. Epidermal inclusion cyst. Three round yellow (keratin) cysts of varying sizes in the lateral canthal area.
FIGURE 15.3. Verruca vulgaris. A, A small lesion presenting as a flesh-colored skin projection on the right lower lid. B, A larger lesion with the classic digitated projections on the right upper lid.
Management
Marsupialization or complete excision of the cyst and cyst contents.
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