 |
Slide 1 |
Howard J. Loff, MD · Michael Landa, MD
|
Eyelid lesions can be benign, premalignant, or malignant. The history and clinical diagnosis are extremely important in determining the probability of malignancy. The growth rate, change in size or color, sun exposure, or prior history of cancer can provide additional information in determining the likelihood of malignancy. Clinical findings that are characteristic for malignancy are destruction of lid margin architecture, particularly meibomian gland orifices, and bleeding or ulceration of the lesion.1
Sudiferous cysts are clear, cystic lesions arising from blocked glands of Moll. Treatment is with surgical excision. Simple drainage without removing the cyst frequently results in recurrence (Slide 1).
Epidermal inclusion cysts arise from abnormal implantation of the epidermis in the dermis. These can be congenital or traumatic and typically are slowly progressive, firm, freely moving, subepithelial lesions.2
|
Associated Syndromes
Torre syndrome is associated with multiple sebaceous gland tumors and visceral carcinomas. Gardner
syndrome involves intestinal polyposis, facial bone osteomas, and fibromatosis of the abdomen or breast.
Treatment is with surgical excision.
|
Sebaceous cysts arise from obstruction of Zeis, meibomian, or sebaceous glands associated with hair follicles. They are subcutaneous, cystic lesions that are white or yellowish in appearance (Slide 2). Treatment is with surgical excision. Simple drainage without removing the cyst frequently results in recurrence.
Milia are umbilicated, multiple superficial lesions arising from pilosebaceous units. They are elevated, round white tumors approximately the size of a pinhead. Treatment is with surgical excision, electrolysis, laser, or diathermy.
|
Squamous papilloma are benign hyperplastic lesions that arise from squamous epithelium. These lesions can be solitary, pedunculated, or sessile with a nodular or papillomatous surface. Treatment is with surgical excision.
Seborrheic keratosis is a superficial pigmented, friable lesion that is well circumscribed without any dermal extension (Slide 3). Treatment with curettage or scissors excision is usually adequate; carbon dioxide (CO2) ablation may be effective for larger lesions.
Keratoacanthoma are elevated, dome-shaped lesions that rapidly grow with a crater-like central keratin-filled core. These lesions may regress and involute on their own; otherwise surgical excision, curettage, cauterization, cryosurgery, or CO2 ablation may be worthwhile.
|
Actinic keratosis lesions are flat, scaly, papillomatous ulcerated lesions that typically involve sun exposed areas. They can undergo malignant changes resulting in basal or squamous cell carcinoma.
Pyogenic granuloma are vascular lesions that occur after trauma or surgery. They are typically fast growing, pedunculated, fleshy tumors with superficial ulceration of the epithelium. Treatment is with surgical excision.
Xanthelasma frequently occurs in the medial canthal regions. These lesions are superficial, elevated plaques that histologically contain "foamy histiocytes." They may be associated with elevated cholesterol or triglyceride levels in patients younger than 40 years of age3 (Slide 4). Treatment is with surgical or CO2 excision.
|
A chalazion is a tarsal inflammation, which involves the meibomian or Zeis glands (Slide 5). Conservative treatment with warm compresses or topical or oral antibiotics is frequently effective. Otherwise, local steroid injection or incision and drainage may be necessary.
Ephelis (freckles) are macular pigmented lesions with increased amounts of melanin in the basal cell layer. They are frequently found in sun exposed areas.
|
Lentigo are similar to ephelis, but can be found on non-sunexposed skin.
Nevus are congenital, well-demarcated lesions that are smooth or verrucous and can be flesh-colored or pigmented. They are classified according to their location: junctional (involving the junction of the epidermis and dermis), intradermal (within the dermis), or compound (both junctional and intradermal)4 (Slide 6).
Molluscum contagiosum is a viral infection involving the epidermis, producing an umbilicated, small dome shaped lesion. If this infection involves the lid margin, it can cause a chronic follicular conjunctivitis (Slide 7). Surgical treatment involves cryosurgery, curettage, or excision.
Verruca (wart) is a viral infection of the epidermis with papovavirus. This results in lesions being elevated, papillomatous (verruca vulgaris) or smooth, flat sessile with minimal pigmentation (verruca plana). Complete excision is the ideal treatment to prevent recurrence.
