History
In addition to general questions about past medical history and family history, document the following:
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Determine how long the lesion has been present.
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Determine if the lesion has grown (eg, rapidly, slowly).
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Determine if the lesion has changed in any way (eg, color, bleeding, ulceration).
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Ask the patient if any similar lesions have occurred before anywhere on the patient's body.
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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 (sun) exposure is the main etiologic factor.