Eyelid Papilloma

Updated: Nov 09, 2023
  • Author: Saif Aldeen Saleh Alryalat, MD; Chief Editor: Hampton Roy, Sr, MD  more...
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Overview

Practice Essentials

Eyelid papilloma, commonly referred to as a "skin tag," is a benign growth that can present clinical significance despite its usually innocuous nature. [1] The following is a brief description of eyelid papilloma and its management:

  • Physical characteristics: This soft, flesh-colored lesion is recognizable by its smooth or round contour, often accompanied by a 'stalk-like' or pedunculated appearance.

  • Prevalence: Holding the title of the most common benign epithelial tumor of the eyelid, the eyelid papilloma emphasizes the need for clinicians to be familiar with its presentation and management.

  • Demographics: Typically observed in middle-aged or older adults, its distinct age association aids in differential diagnosis and helps differentiate it from other potential young-age growths.

  • Management considerations: In dealing with eyelid papilloma, treatment often is dictated by the lesion's presentation and severity. Asymptomatic benign papillomas that don't present significant cosmetic concerns can be observed without immediate intervention. If diagnosis is uncertain, early incisional or excisional biopsies become essential. For symptomatic cases, excision is standard. Throughout these procedures, safeguarding vital ocular structures like the canthal tendons and lacrimal apparatus is vital. Complete excision, when feasible, is advocated to minimize recurrence risk and ensure the best therapeutic outcome.

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Background

The term "papilloma" derives from the Latin word "papilla," meaning nipple, reflecting the growth's nipple-like or protruding appearance on the skin or mucous membranes. It also is associated with the human papillomavirus (HPV), a group of viruses known to cause wart-like growths on the skin and mucous membranes, highlighting the etymological and clinical link between the term "papilloma" and the virus. An eyelid papilloma is the most common benign epidermal tumor. Lesions usually are papillomatous, that is, of smooth, rounded, or pedunculated elevation. [2, 3, 4, 5, 6]  The lesion that most commonly fits this description is a benign squamous papilloma. However, it is possible that other benign or malignant eyelid lesions, including squamous cell carcinoma, may take on a similar appearance.

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Pathophysiology

The majority of eyelid tumors primarily stem from the cutaneous origins. Delving further into this classification, the most prevalent eyelid tumors can be categorized into 2 subgroups: epithelial and melanocytic tumors, both of which are mostly of epidermal origin. The precise etiology of squamous cell papilloma (SCP) remains a topic of debate among medical professionals, as it is yet to be universally confirmed. Despite this uncertainty, a few prime culprits have been consistently highlighted in the literature. Notably, both mechanical and chemical irritations are implicated as potential triggers, along with infections by certain strains of the human papillomavirus (HPV). The involvement of HPV in the pathogenesis of SCP is particularly noteworthy. HPV6 and HPV11 stand out as the 2 most frequently associated genotypes with SCPs. However, it's crucial to mention that while the high-risk HPV16 and 18 have been identified in SCPs, their prevalence is significantly lower compared to HPV6 and HPV11. [6]

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Epidemiology

Frequency

International

Squamous papilloma represents the most common benign lesion of the eyelid. Results of a retrospective analysis of eyelid tumors showed that epidermal tumors are the most common eyelid tumors, with papilloma being the most common. Eyelid papilloma represents 10-26% of all eyelid tumors based on thousands of cases of eyelid tumors from around the world. [2, 3, 4, 5]  In a single study in Turkey, eyelid papilloma was the second most common after Seborrheic Keratosis.

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 typically occur in middle-aged or older adults.

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Prognosis

Prognosis is excellent. However, the lesions can recur in the same or different location.

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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.

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