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Ophthalmology > LID
Papilloma, Eyelid
Article Last Updated: Apr 10, 2008
AUTHOR AND EDITOR INFORMATION
Section 1 of 9  
Author: Mounir Bashour, MD, CM, FRCS(C), PhD, FACS, Assistant Professor of Ophthalmology, McGill University; Clinical Assistant Professor of Ophthalmology, Sherbrooke University; Medical Director, Cornea Laser and Lasik MD
Mounir Bashour is a member of the following medical societies: American Academy of Ophthalmology, American Association for Pediatric Ophthalmology and Strabismus, American College of International Physicians, American College of Surgeons, American Medical Association, American Society of Cataract and Refractive Surgery, American Society of Mechanical Engineers, American Society of Ophthalmic Plastic and Reconstructive Surgery, Biomedical Engineering Society, Canadian Medical Association, Canadian Ophthalmological Society, Contact Lens Association of Ophthalmologists, International College of Surgeons US Section, Ontario Medical Association, Quebec Medical Association, and Royal College of Physicians and Surgeons of Canada
Editors: Brian A Phillpotts, MD, Former Vitreo-Retinal Service Director, Former Program Director, Clinical Assistant Professor, Department of Ophthalmology, Howard University College of Medicine; Simon K Law, MD, PharmD, Assistant Professor of Ophthalmology, Jules Stein Eye Institute; Chief of Section of Ophthalmology Surgical Services, Department of Veterans Affairs Healthcare Center, West Los Angeles; Mark T Duffy, MD, PhD, Consulting Staff, Division of Oculoplastic, Orbito-facial, Lacrimal, and Reconstructive Surgery, Green Bay Eye Clinic, BayCare Clinic; Lance L Brown, OD, MD, Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri; Hampton Roy Sr, MD, Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences
Author and Editor Disclosure
Synonyms and related keywords:
eyelid papilloma, squamous papilloma, benign eyelid lesions
Background
An eyelid papilloma is any lesion on the eyelid that is papillomatous, that is, of smooth, rounded, or pedunculated elevation. The lesion that most commonly fits this description is a benign squamous papilloma. However, it is possible that other benign eyelid lesions may take on the same appearance, as well as malignant skin lesions, especially squamous carcinoma. Malignant eyelid skin conditions are covered in other articles; this article outlines benign skin lesions.
Pathophysiology
Squamous papilloma is a benign tumor of epithelial origin.
Frequency
International
Squamous papilloma is the most common benign lesion of the eyelid.
Race
No known differences in race presentation or frequency exist.
Sex
No difference in occurrence exists between the sexes.
Age
Frequency increases steadily with age, but they may occur at any age and are seen most frequently in patients older than 30 years.
History
In addition to general questions about past medical history and family history, document the following:
- Determine how long the lesion has been present.
- Determine if the lesion has grown (eg, rapidly, slowly).
- Determine if the lesion has changed in any way (eg, color, bleeding, ulceration).
- Ask the patient if any similar lesions have occurred before anywhere on the patient's body.
- Ask the patient if a malignant skin lesion has occurred before.
Physical
Check the skin for additional lesions, and palpate the preauricular and submaxillary lymph nodes for metastasis if suspecting a malignant lesion.
- Slit lamp examination
- Look for telangiectasias on nodular tumors, evaluate for loss of eyelashes (madarosis) or whitening of eyelashes (poliosis) in the region of the tumor, and inspect the meibomian orifices to determine whether they have been destroyed.
- Ulceration and inflammation with distortion of the eyelid anatomy, abnormal color, texture, or persistent bleeding suggest malignancy.
Causes
No known cause for squamous papilloma exists. However, for most malignant lesions, UV exposure is the main etiologic factor.
Basal Cell Carcinoma, Eyelid
Chalazion
Hemangioma, Cavernous
Hordeolum
Molluscum Contagiosum
Neurofibromatosis-1
Pigmented Lesions of the Eyelid
Sebaceous Gland Carcinoma
Squamous Cell Carcinoma, Eyelid
Xanthelasma
Other Problems to be Considered
Benign eyelid lesions
Seborrheic keratosis
Keratoacanthoma Cysts
Nevus
Actinic keratosis
Verrucae
Benign tumors of hair follicles or sweat glands
Inverted follicular keratosis
Neurofibroma
Neurilemoma
Capillary hemangioma
Pseudoepitheliomatous hyperplasia
Necrobiotic xanthogranuloma
Multiple myeloma Malignant eyelid lesions
Malignant melanoma
Lymphoma
Sweat gland carcinoma
Metastasis
Imaging Studies
- Ultrasound biomicroscopy (UBM) at 50 MHz has recently been tried in detecting malignancy of various eyelid lesions and has been shown to have a sensitivity of 78-86% and a specificity of 37-69%; that is, UBM can help differentiate between benign eyelid lesions and malignant eyelid lesions.1
Procedures
- Consideration should be given to photographing the lesion.
- A biopsy of the lesion may be performed.
- Accurate diagnosis of an eyelid lesion requires histologic examination.
Histologic Findings
Usually, squamous papillomas are sessile or pedunculated and have a color similar to the surrounding skin. They often are multiple and tend to involve the lid margin. A small keratin crust often can be palpated on the surface (keratotic papilloma). Microscopically, these lesions are composed of fingerlike projections of vascularized connective tissue covered by hyperplastic epithelium (papillae). The epidermis usually is acanthotic, with elongation of the rete ridges, and shows areas of hyperkeratosis and focal parakeratosis.
Surgical Care
Surgical excision usually is a simple procedure for these benign skin lesions.
Further Outpatient Care
- Patients should receive follow-up care as needed.
Complications
- Surgical scarring and possibly lid notching are the only likely complications. Usually, the lesions are so small that bleeding and infection rarely occur postexcision.
- Premalignant, malignant, or benign eyelid skin lesions may be papillomatous.
- Cysts - Epidermal inclusion, sudoriferous, sebaceous
- Seborrheic keratosis usually occurs in middle-aged or elderly patients and appears as brown-black, "stuck on," well-circumscribed, crustlike lesions. Usually, the lesions are slightly elevated and uninflamed. The lesions can be removed with a shave biopsy, if desired. In black adults, a heavily pigmented variant, dermatosis papulosa nigra, occurs involving the malar region and often the eyelids.
- Keratoacanthoma appears similar to basal cell carcinoma and squamous cell carcinoma because it is elevated with a central ulcer crater. However, these dome-shaped tumors with rolled margins usually appear and rapidly grow in size (up to 1-2 cm) over a few weeks to months and then often spontaneously involute. The tumors can be destructive, especially if they involve the eyelash margin. To be sure of the diagnosis, surgical excision and biopsy often is performed. These tumors can occur in individuals who are immunosuppressed (eg, after renal transplantation).
- Nevus is usually light to dark brown, but it can be amelanotic and indistinguishable from a squamous papilloma. Usually, it is well circumscribed, sometimes with hair growing from its surface. It does not grow in size.
- Inverted follicular keratosis usually presents as a solitary nodular or wartlike keratotic mass, it may be pigmented simulating a melanocytic lesion. It also can present as a cutaneous horn. If incompletely excised, it has a tendency to recur.
- Pseudoepitheliomatous hyperplasia often clinically and histopathologically is confused with carcinoma. Usually, it is elevated with an irregular, ulcerated, or crusted surface, mimicking squamous cell carcinoma or basal cell carcinoma. It can occur anywhere on the eyelid and usually is of short duration (weeks to months). They may be associated with mycotic infections, insect bites, drugs, burns, radiation therapy, and underlying malignant lymphoma.
Prognosis
- Prognosis is excellent. However, the lesions can recur in the same or different location.
Patient Education
- Warn patients to protect their skin from the sun's damaging influence, with hats, sunglasses, and protective lotions, and to minimize exposure to the sun. See a medical practitioner if any new lesions appear.
Medical/Legal Pitfalls
- Failure to perform a biopsy of a lesion that turns out to be malignant
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- Rodriguez-Sains RS. Ophthalmologic oncology: common eyelid tumors. J Dermatol Surg Oncol. Apr 1982;8(4):247-53. [Medline].
- Rumelt S, Pe'er J, Rubin PA. The clinicopathological spectrum of benign peripunctal tumours. Graefes Arch Clin Exp Ophthalmol. Feb 2005;243(2):113-9. [Medline].
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Papilloma, Eyelid excerpt Article Last Updated: Apr 10, 2008
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