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BENIGN EYELID LESIONS1. Nodules
• Chalazion
• Acute hordeola
2. Cysts
•
• Cyst of Moll• Cyst of Zeiss• Sebaceous cyst• Hidrocystoma
• May be multiple in AIDS patients • Occasionally superficial keratitis
Signs Complications
Histology of molluscum contagiosum
• Lobules of hyperplastic epithelium
• Circumscribed lesion• Surface covered by normal epithelium except in centre
• Intracytoplasmic (Henderson-Patterson) inclusion bodies• Deep within lesion bodies are small and eosinophilic• Near surface bodies are larger and basophilic
Xanthelasma
• Usually bilateral and located medially
• Common in elderly or those with hypercholesterolaemia• Yellowish, subcutaneous plaques containing cholesterol and lipid
• Translucent• On anterior lid margin
Cyst of Moll
• Similar to cyst of Moll • Not confined to lid margin
Eyelid cysts
• Opaque• On anterior lid margin
Cyst of Zeis
Eccrine sweat gland hidrocystoma
Sebaceous cyst
• Cheesy contents • Frequently at inner canthus
Viral wart (squamous cell papilloma)• Most common benign lid tumour• Raspberry-like surface
Pedunculated Sessile
Histology of viral wart
Finger-like projections of fibrovascular connective tissue
Epidermis shows acanthosis (increased thickness) and hyperkeratosis
Rete ridges are elongated and bent inwards
Seborrhoeic
• Common in elderly• Discrete, greasy, brown lesion• Friable verrucous surface• Flat ‘stuck-on’ appearance
Actinic
• Most common pre-malignant skin lesion• Rare on eyelids
• Affects elderly, fair-skinned individuals
• Flat, scaly, hyperkeratotic lesion
Keratoses
Keratoacanthoma
• Uncommon, fast growing nodule• Acquires rolled edges and keratin-filled crater
• Involutes spontaneously within 1 year
• Lesion above surface epithelium
• Central keratin-filled crater
• Chronic inflammatory cellular infiltration of dermis
Naevi• Appearance and classification determined by location within skin• Tend to become more pigmented at puberty
• Elevated
Intradermal
• May be non-pigmented
• No malignant potential
• Flat, well-circumscribed
• Low malignant potential
Junctional
• Has both intradermal and junctional components
Compound
• Pigmented
Capillary haemangioma
• Rare tumour which presents soon after birth
• Starts as small, red lesion, most frequently on upper lid
• Blanches with pressure and swells on crying
• Grows quickly during first year
• May be associated with intraorbital extension
• Begins to involute spontaneously during second year
Periocular haemangioma
• Steroid injection in most cases• Surgical resection in selected cases
• High-out heart failure
Treatment options
Occasional systemic associations
• Kasabach-Merritt syndrome - thrombocytopenia, anaemia and reduced coagulant factors
• Maffuci syndrome - skin haemangiomas, endrochondromas and bowing of long bones
Histology of capillary haemangioma
Lobules of capillaries Fine fibrous septae Lobules under high magnification
Port-wine stain (naevus flammeus)
• Rare, congenital subcutaneous lesion
• Segmental and usually unilateral
• Does not blanch with pressure
• Ipsilateral glaucoma in 30%
• Sturge-Weber or Klippel-Trenaunay-Weber syndrome in 5%
Associations
Progression of port-wine stain
Initially red and flat Subsequent darkening and hypertrophy of skin
Skin becomes coarse, nodular and friable
Pyogenic granuloma
• Usually antedated by surgery or trauma• Fast-growing pinkish, pedunculated or sessile mass• Bleeds easily
Cutaneous horn
• Uncommon, horn-like lesion protruding through skin• May be associated with underlying actinic keratosis or squamous cell carcinoma