3: Eyelids- Benign Lesions Flashcards
papule
a bump, palpable and circumscribed, elevated and less than 5 mm in diameter; may be pigmented, erythematous, or flesh-toned; example: elevated nevus (mole)
nodule
a lesion similar to a papule, with a diameter of 5 mm to 2 cm; may have a significant palpable dermal component; examples: fibroma, xanthoma, intradermal nevi
oculodermal melanocytosis (nevus of Ota)
hyperpigmentation of the eyelid, sclera, and uvea
oculodermal melanocytosis (nevus of Ota) etiology
- proliferation of melanocytes
- congenital
oculodermal melanocytosis (nevus of Ota) demographics
- most commonly affects Asian and African descent
- women > men
oculodermal melanocytosis (nevus of Ota) laterality
unilateral
oculodermal melanocytosis (nevus of Ota) symptoms
- asymptomatic
- gray, blue, or black area on eyelid
oculodermal melanocytosis (nevus of Ota) signs
- gray, blue, or black eyelid and/or facial hyperpigmentation (hyperpigmentation of the skin frequently follows the distribution of CN V1 and CN V2)
- patchy but extensive slate-gray or blue scleral hyperpigmentation
- variable amounts of uveal hyperpigmentation (darker iris, increased pigment in the angel, darker fundus)
- may have iris mammillations
- diffuse iris nevus
- scleral or choroidal melanocytosis most common
oculodermal melanocytosis (nevus of Ota) complications
- secondary open angle glaucoma (pigment blocks the TM)
- malignant potential, may evolve to melanoma (most common melanoma is uveal)
oculodermal melanocytosis (nevus of Ota) management
- monitor for glaucoma (ONH evaluation with DFE, OCT, GCC, HVF 24-2)
- monitor for melanoma (SL exam, ASeg photos)
- if symptomatic/cosmesis, refer out for laser therapy for skin discoloration (may cause scarring, hyperpigmentation may recur)
oculodermal melanocytosis (nevus of Ota) clinical pearls:
- _____ are least likely to have condition, but most likely to develop melanoma
- if only the sclera and uvea is involved, known as _____ (same risk for glaucoma and transformation into uveal melanoma)
- if only the sclera is involved, known as _____ (typically bilateral, small patches of slate-gray scleral pigmentation; benign condition)
Caucasians;
ocular melanocytosis;
scleral melanocytosis
xanthelasma
benign, lipid-laded plaques at the level of the dermis on the eyelids
xanthelasma etiology
may be associated with hyperlipidemia/hypercholesterolemia
xanthelasma demographics
typically occurs over the age of 40
xanthelasma laterality
bilateral»_space; unilateral
xanthelasma symptoms
- asymptomatic, cosmesis
- yellow plaques around the eyes
xanthelasma signs
- multiple»_space; singular, soft yellow plaques
- typically involves the medial canthus upper eyelids > lower eyelids
xanthelasma management
- monitor if asymptomatic
- if symptomatic (cosmesis), consider scope of practice for removal vs. referral out for removal (size); surgical excision, cryotherapy, laser treatment, chemical cauterization; potential for recurrence, suggests uncontrolled hypercholesterolemia
- if no previous diagnosis of hypercholesterolemia and patient is under 40, consider ordering lipid panel or refer to PCP
port-wine stain (nevus flammeus)
benign, dilated capillaries in the dermis
port-wine stain (nevus flammeus) etiology
- congenital
- may be associated with Sturge-Weber syndrome (if hemifacial dermatome pattern, think Sturge-Weber)
port-wine stain (nevus flammeus) demographics
present at birth
port-wine stain (nevus flammeus) laterality
unilateral > bilateral
port-wine stain (nevus flammeus) symptoms
red birthmark, cosmesis
port-wine stain (nevus flammeus) signs
- flat, smooth, pink patch (can thicken and darken to a more purple color over time)
- grows proportionately with the child
- tends to follow dermatomal distribution
- lesion is more prone to bleeding if scratched or injured
port-wine stain (nevus flammeus) management
- none if asymptomatic
- if symptomatic, refer out for laser surgery (causes the capillaries to burst, leads to gradual lightening, multiple laser treatments are necessary, cannot completely remove the lesion)
port-wine stain (nevus flammeus) clinical pearls:
-can occur _____
anywhere on the skin; tend to appear on one side of the face, head, and neck, but may also affect the abdomen, legs, or arms
Sturge-Weber syndrome
- congenital neurological disorder caused by a gene mutation
- features include facial port wine stain, choroidal hemangioma, intracranial vascular abnormalities, unilateral glaucoma (due to increased venous pressure)
- port-wine stain that involves V1 and V2 is more likely associated with Sturge-Weber
capillary hemangioma
benign vascular tumor
capillary hemangioma etiology
proliferation of vascular endothelial cells
capillary hemangioma demographics
apparent during first few months of life (usually 3-6 months)
capillary hemangioma laterality
unilateral
capillary hemangioma symptoms
red or blue area on eyelid
capillary hemangioma signs
- cutaneous lesion (bright red nodule; blanch with pressure)
- subcutaneous lesion (bluish discoloration underneath normal skin)
- enlarge and/or change color with crying
- ptosis
- induced astigmatism
capillary hemangioma complications
amblyopia (refractive or deprivation)
capillary hemangioma management
- monitor for regression (~75% of lesions will resolve over 4 years)
- correct refractive error
- if visual obstruction or astigmatism leading to amblyopia or severe cosmesis, refer out for treatment (propranolol is treatment of choice; topical beta-blocker can be tried for small lesions; oral or injectable steroid; laser photocoagulation)
capillary hemangioma clinical pearls:
- can occur _____
- enlarge rapidly over _____, then regress over _____
anywhere on the body; ocular involvement includes the eyelids, conj, and orbit;
weeks to months; months to years
conjunctival capillary hemangioma
bright red nodule on the conj; similar treatment to eyelid hemangioma
orbital capillary hemangioma
proptosis; MRI or CT scan to confirm diagnosis; similar treatment to eyelid hemangioma
epidermoid cyst (epidermal inclusion cyst)
benign, superficial cyst filled with keratin
epidermoid cyst (epidermal inclusion cyst) etiology
- surface skin cells (epidermal tissue) move deeper into the skin (the dermis) and multiply forming a wall; these cells secrete keratin which fills the cyst
- congenital or acquired; likely a result of trauma to the skin (past surgery, laceration, etc.)
epidermoid cyst (epidermal inclusion cyst) demographics
no predilection
epidermoid cyst (epidermal inclusion cyst) laterality
unilateral or bilateral
epidermoid cyst (epidermal inclusion cyst) symptoms
- asymptomatic, cosmesis
- “bump” or cyst on eyelid
epidermoid cyst (epidermal inclusion cyst) signs
- flesh-colored or yellow-white elevated, mobile, smooth papule or nodule; white color most common in newer-onset cyst; becomes darker as keratin incorporates dead skin cells
- NOT translucent!
- surrounding inflammation if cystic wall ruptures within the skin
epidermoid cyst (epidermal inclusion cyst) management
- surgical excision for removal
- unmanaged can slowly progress until ruptures
- cystic wall needs to be removed to prevent recurrence
epidermoid cyst (epidermal inclusion cyst) clinical pearls:
- can occur ____
- multiple, tiny, superficial epidermoid cysts are called ____
anywhere on the skin;
milia
sebaceous cyst
benign, superficial cyst filled with sebum
sebaceous cyst etiology
- blockage of a sebaceous gland with retention of sebum
- if located on the eyelid margin, called a cyst of Zeis
- likely a result of trauma to the skin
sebaceous cyst demographics
no predilection
sebaceous cyst laterality
unilateral or bilateral
sebaceous cyst symptoms
- asymptomatic, cosmesis
- “bump” on eyelid
sebaceous cyst signs
- flesh-colored to yellow papule or nodule (dome-shaped bump)
- surrounding inflammation if cystic wall ruptures within the skin
sebaceous cyst management
- none if asymptomatic; may spontaneously regress
- surgical excision for removal; cystic wall needs to be removed to prevent recurrence
sebaceous cyst clinical pearls:
-can occur _____
anywhere on the skin (called a cyst of Zeis if it is located on the eyelid margin!)
sudoriferous cyst (hidrocystoma)
benign, superficial cyst filled with sweat
sudoriferous cyst (hidrocystoma) etiology
- blockage of a sweat gland with retention of sweat
- eccrine= adnexal, apocrine= canthi/hair follicle
- likely a result of friction, mechanical trauma to the skin
sudoriferous cyst (hidrocystoma) demographics
- no predilection
- can be more common with sweaty conditions, heat, and humidity
sudoriferous cyst (hidrocystoma) laterality
unilateral or bilateral
sudoriferous cyst (hidrocystoma) symptoms
- asymptomatic, cosmesis
- “bump” on eyelid
- itching, discomfort
- Hx of increase in size over weeks to months
- Hx of previous drainage, either spontaneously or by practitioner
sudoriferous cyst (hidrocystoma) signs
- flesh-colored, round, mobile papule or nodule (dome-shaped bump); translucent and transilluminates*
- surrounding inflammation if cystic wall ruptures within the skin
sudoriferous cyst (hidrocystoma) management
- none if asymptomatic; educate pt on cycle of regression and recurrence
- surgical excision for removal; cystic wall needs to be removed to prevent recurrence (still a chance of recurrence after removal); incision and drainage is no longer considered adequate Tx
sudoriferous cyst (hidrocystoma) clinical pearls:
- highly _____
- can occur _____; if located on the eyelid margin it is _____
- multiple, tiny hidrocystomas are called _____; most common on ______
recurrent; anywhere on the skin; apocrine aka a cyst of Moll; syringoma; cheeks and lower eyelids
squamous papilloma (papilloma, skin tag)
benign epidermal tumor
squamous papilloma (papilloma, skin tag) etiology
- proliferation of squamous epithelial cells overlying a fibrovascular core; variable degrees of hyperkeratosis (irregular keratinized stratified squamous epithelium covering the epidermis)
- may be a response to a viral infection; most commonly HPV; aka verruca vulgaris if viral
squamous papilloma (papilloma, skin tag) demographics
- if associated with HPV, young adults are more commonly affected
- if non-viral, typically develops after the age of 40
squamous papilloma (papilloma, skin tag) laterality
unilateral or bilateral
squamous papilloma (papilloma, skin tag) symptoms
- asymptomatic, cosmesis
- “bump” or “stalk” on eyelid
- irritation of the bump (e.g., tenderness, itching) with manipulation
squamous papilloma (papilloma, skin tag) signs
- flesh-colored or hyperpigmented papule or nodule (dome-shaped bump); pedunculated (containing a stalk) or sessile (no stalk); rough or smooth surface
- surrounding inflammation if rubbed constantly (from clothes, picking)
squamous papilloma (papilloma, skin tag) management
- none if asymptomatic; may spontaneously regress/fall off; chance of recurrence if not excised
- surgical excision for removal; entire lesion needs to be removed or may recur, esp. if viral etiology
squamous papilloma (papilloma, skin tag) clinical pearls:
- can occur ______
- most common ______
anywhere on the skin, frequently develops in skin folds (e.g., neck, eyelids);
benign eyelid lesion
seborrheic keratosis
benign epidermal tumor
seborrheic keratosis etiology
proliferation of basal epithelial cells with keratin filled invaginations
seborrheic keratosis laterality
unilateral or bilateral
seborrheic keratosis symptoms
- asymptomatic, cosmesis
- “bump” or “scab” on eyelid/adnexa
- irritation of the bump (e.g., tenderness, itching) with manipulation
seborrheic keratosis signs
- hyperpigmented papule or nodule (dome-shaped bump); slightly elevated from the skin with a stuck-on appearance; rough or smooth surface; waxy and granular to velvety texture
- surrounding inflammation if rubbed constantly (mainly from clothes)
seborrheic keratosis management
- none if asymptomatic; may spontaneously regress; chance for recurrence with or without Tx
- surgical excision for removal; curretage/scraping, cryotherapy, chemical cautery, cautery, laser
seborrheic keratosis clinical pearls:
- can occur ____
- if multiple papules on the face, called ____; more common with _____
- name is a misnomer; it is not _____
anywhere on the skin;
papulosa nigra;
African Americans and Asians;
seborrheic (relating to excessive discharge of sebum from sebaceous glands)
melanocytic nevus (mole)
benign epidermal/dermal tumor
melanocytic nevus (mole) etiology
- proliferation of melanocytes
- junctional: melanocytes clump at the epidermal/dermal junction
- compound: melanocytes extend from the epidermis into the dermis
- intradermal: melanocytes clump within the dermis; most common
- associated with UV exposure
melanocytic nevus (mole) demographics
- often appear during puberty
- more common in Caucasians
melanocytic nevus (mole) laterality
unilateral or bilateral
melanocytic nevus (mole) symptoms
- asymptomatic
- “bump” or mole, “dark spot” on eyelid
melanocytic nevus (mole) signs
- uniformly pigmented macule (flat lesion), papule, or nodule (dome-shaped bump)
- most commonly tan, brown, or black; rarely, can be a blue nevus
- may be amelanotic (pink)
- most common location in regards to the eyelid is on the margin
- flat or slightly elevated
melanocytic nevus (mole) complications
-malignant potential- most important sign is documented change (however, may increase in size during puberty)
melanocytic nevus (mole) management
- monitor for melanoma: SL exam, ASeg photos
- surgical excision for removal; biopsy for suspicious lesions
melanocytic nevus (mole) clinical pearls:
- can occur _____
- use ____ to confirm benign lesion
- use _____ to catch change over time/potential malignant development
anywhere on the skin;
pertinent negatives;
pertinent malignant descriptors
