Eyelid Papilloma 

Updated: Aug 17, 2018
Author: Mounir Bashour, MD, PhD, CM, FRCSC, FACS; Chief Editor: Hampton Roy, Sr, MD 

Overview

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.

Epidemiology

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.

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.

 

Presentation

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 (sun) exposure is the main etiologic factor.

 

DDx

 

Workup

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.[2]

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.

 

Treatment

Medical Care

Lee et al studied eyelid margin papillomas for which complete excision was cosmetically unacceptable. The study reported a case in which interferon was an effective treatment for a conjunctival papilloma.[3]

Surgical Care

Surgical excision usually is a simple procedure for these benign skin lesions.

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.

Long-Term Monitoring

Patients should receive follow-up care as needed.