The document describes the steps for examining an eyelid mass, including inspection and palpation to evaluate characteristics like shape, size, color, texture, and mobility. It then covers the anatomy and types of benign and malignant eyelid lesions. Common benign lesions include seborrheic keratosis, actinic keratosis, melanocytic nevi, dermoid cysts, and chalazia. Malignant lesions include basal cell carcinoma and melanoma. Surgical excision is a common treatment, while some lesions may be observed or treated with cryotherapy, laser, or radiation.

2. Eyelid Anatomy

13. -Local examination of an eyelid mass includes the following steps:
 Look (shape – site – extension – color – texture – loss of lashs)
 Feel (tempreature – tenderness – surface…..)
 Edge (well defined – indistinct)
 Consistency (hard – soft – spongy…..)
 Press (pulsation – fluctuation – compression)
 Move (mobility – fixation….)
 listen (bruit) for AV malformations
 transillumination
 Measure
 Draining group of lymph nodes
 Photographic documentation
Technique for LocalExamination of the
Eyelid Mass

14. I. Epidermis Tumors
II. Sebaceous gland Tumors
III. Sweat gland Tumors
IV. Hair follicle Tumors
V. Melanocytic Tumors
VI. Neural Tumors
VII. Vascular Tumors
VIII. Cystic lesions
IX. Inflammatory lesions
X. Miscellaneous lesions
Benign Eyelid Lesions

15.  Squamous papilloma:
the most common benign eyelid lesions
middle or elderly age
slow grow
sessile or pedunculated
solitary or multiple
pigmented or siamilar to skin color
irregular surface with keratinized crust
formation common
Excision or laser
Epidermis Tumors

16.  Seborrheic Keratosis:
basal cell papilloma
common
slow grow
elderly age
well circumscribed, waxy,friable ,greasy,and
appear stuck to the skin
round to oval, and may be multiple or
pigmented
Excision or laser
Epidermis Tumors

17. Actinic Keratosis:
solar keratosis
common
slow grow
elderly age
reddish-brown scaly patches in sun
exposed areas of the lids and are 3–10 mm
in diameter
cryotherapy or curettage
Excision for larger lesion
Epidermis Tumors

18. Keratoacanthoma:
It recently was reclassified as alow-grade form of
squamous carcinoma.
104 cases per 100,000 in the white population
rapidly grow over a period of
2–6 months
elderly age
dome-shaped tumors with distinct borders and a
central keratin core.
observation, to cryoapplication, to surgical
resection. There have been some reports of
spontaneous regression.
Epidermis Tumors

19. Sebaceous.G Hyperplasia and Adenoma:
Hyperplasia and adenoma of the sebaceous
glands(zeis ,meibomian,caruncle…)
systemic association with *Muir-Torre syndrome
any age but are more common in young
adulthood.
yellowish nodule of the lid
observed, or a simple surgical excision
Sebaceous gland Tumors
*This syndrome is an autosomal dominant condition in which patients with cutaneous sebaceous tumors, basal cell carcinoma, or keratoacanthoma have a high incidence of visceral malignancy,
especially colon cancer. Almost 70 % of these patients have a positive family history.

20. Syringoma:
benign tumors of the eccrine sweat glands
around the lid and adnexae
common
young females but may present at any age
yellowish small papules that are often
multiple and bilateral
observation,excision,Laser
Sweat gland Tumors

21. Trichoepithelioma
Trichofolliculoma
Trichilemmoma
Pilomatrixoma (calcifying epithelioma of Malherbe)
Hair follicle Tumors

22. Trichoepithelioma:
benign adnexal neoplasm.
The gene involved in the familial form of
trichoepithelioma is located on band 9p21
Slow grow
appearing in childhood and gradually increase in
number with aging
single or multiple papules or nodules typically are
observed on the lid skin and face.
The lesions are round, skin-colored, firm papules
or nodules that are 2–8 mm in diameter
may be associated with other cutaneous tumors
solitary lesions may be excised
laser may be used to manage huge cluster lesions
Recurrence of a solitary trichoepithelioma is
uncommon
Hair follicle Tumors

23. Pilomatrixoma:
the commonest hair follicle proliferation
composed of islands of basophilic cells
surrounding eosinophilic shadow cells
children and young adults and is more
common in females
mobile purplish dermal nodule that may
have a hard consistency due to calcification
Malignant change is rare
excision
Hair follicle Tumors

24. Melanocytic Nevus:
benign tumor derived from cutaneous melanocytes.
Nevus may be either congenital or acquired.
congenital nevus usually appears sometime after
birth and shows a very slow growth pattern until
puberty. An acquired melanocytic nevus starts
developing in early adulthood and may occur
anywhere over the eyelid skin.
tumors usually are brownish and thick, and they may
range from flat, nonelevated lesions to large nodular
pigmented growths in the eyelid margin, over the
eyelid skin, or even over the eyebrow
Melanocytic Tumors

25. Melanocytic Nevus:
In the eyelid, two very characteristic varieties have been
described:
Kissing nevus, or divided nevus, is a rare form of congenital
nevus
Hairy nevus is a dark-colored, often hairy patch of skin
present in the periocular region at birth. It may occur along
the distribution of the lacrimal drainage system;
sometimes it forms a teardrop pigmentation over the
periocular region
Melanocytic nevus usually is a benign condition. In very
rare situations, the lesion may show a very rapid increase
in pigmentation and growth in middle age, especially in
sun-exposed areas; in these case, malignant conversion
should be suspected
Melanocytic Tumors

26. Melanocytic Nevus:
Treatment is indicated for cosmesis or for
concern about malignancy. Excision should be
complete in most cases, with at least a 3 mm
margin if melanoma is strongly suspected.
Large eyelid nevi may be a cosmetic problem
and require complex and challenging rotational
flaps
Melanocytic Tumors

29. Neurofibroma:
in the eyelid and periorbital region, two forms of
presentation usually are noted:
Plexiform neurofibroma presents as a diffuse and
elongated swelling along the lateral aspect of the
lid and periorbital region. It may range from a
small bulkiness of the lateral upper lid to a
mechanical S-shaped ptosis due to the increased
weight of the lid. In severe forms, a large fold of
skin may occupy the whole lateral side of the face
and usually follows the course of the facial nerve
trunk. These neurofibromas tend to infiltrate
deeper structures, such as fascia, muscle, and
bone.
Neural Tumors

30. Neurofibroma:
Neurofibroma nodules are multiple soft lesions
ranging from small maculopapular lesions to large
nodules or peduncles appearing over the lids,
periorbital region, and face. Similar lesions also
are seen over the trunk and body. They usually
are very slow growing but continue to grow
throughout the patient’s life.
Neural Tumors

31. Neurofibroma:
Treatment of the eyelid involvement is
limited. The lesions do not respond to
radiation therapy. Surgical treatment of
ptosis is often temporary since the
tumors continue to grow. In some
instances, removal of a neurofibroma is
necessary to relieve pain.
Neural Tumors

33. Congenital Capillary Hemangioma:
one of the most common tumours of
infancy
it is three times as common in boys as girls.
It presents shortly after birth as a
unilateral, raised bright red lesion.
The lesion blanches on pressure and may
swell on crying.There may be orbital
extension.
The lesions are composed of a dilated
capillary network resembling the surface of
a strawberry, hence the name strawberry
marks.
Spontaneous involution occurs in most
cases; therefore, observation may be
appropriate. Usually, 40 % of lesions
completely involute by age 4, whereas 80
% completely involute by age 8.
Vascular Tumors

34. Congenital Capillary Hemangioma:
Treatment is indicated principally for amblyopia secondary to
induced astigmatism, anisometropia, occlusion or strabismus,
and less commonly for cosmesis, optic nerve compression or
exposure keratopathy.
The options are:
Beta-blockers Oral propranolol is now widely used, and seems
most effective in the proliferative stage
Steroid
Injection of triamcinolone acetonide (1–2 ml total of 40 mg/ml
over several injection sites) or betamethasone (4 mg/ml) into a
cutaneous or preseptal tumour is usually effective in early
lesions. Regression usually begins within 2 weeks but, if
necessary, second and third injections can be given after about
2 months. It is advisable not to inject deeply into the orbit for
fear of causing occlusion of the central retinal artery due to
retrograde introduction of the suspension. Other
complications include skin depigmentation and necrosis, fat
atrophy and systemic effects such as adrenal suppression.
Oral prednisone (1–2 mg/kg per day given in association with
the child’s pediatrician; treatment usually is for months
Laser may be used to close blood vessels in superficial skin
lesions less than 2 mm in thickness.
Interferon alfa-2a and vincristine may be used for some
steroid-resistant sight-threatening lesions.
radiation
Surgical excision (for debulking; the lesion is not encapsulated,
and there is a risk of recurrence )
Vascular Tumors

35. Nevus Flammeus(Port-Wine Stain)
congenital malformation of vessels within
the superficial dermis
About 10% have associated ocular or CNS
involvement, including Sturge–Weber
syndrome.
reddish to purplish discoloration of the skin
does not blanch with pressure, most
frequently located on the face. It is usually
unilateral typically following the
distribution of the trigeminal nerve. It
usually does not cross the midline.
Different options may be tried, including
freezing, surgical removal, local radiation,
and tattooing.
Vascular Tumors

36. Eyelid Varix:
consists of an abnormally distended vein,
artery, or lymphatic vessel.isolated eyelid
varices are rare
these lesions often enlarge on Valsalva
maneuver. Patients with the orbital
component of varix may present with
proptosis or report visual disturbances.
These lesions are difficult to treat
Ligation of small sections of the varix may
achieve the desired cosmetic effect and
improve patient comfort.
Vascular Tumors

38. Cystic lesions
Cyst of Zeis is a small, non-translucent cyst on the anterior
lid margin arising from obstructed sebaceous gland
associated with the eyelash follicle

39. Cystic lesions
Cyst of Zeis

40. Cystic lesions
Cyst of Moll (apocrine hidrocystoma) is a small retention
cyst of the lid margin apocrine glands. It appears as a round,
non-tender, translucent fluid-filled lesion on the anterior lid
margin

41. Cystic lesions
Epidermal inclusion cyst is usually caused by implantation
of epidermis into the dermis following trauma or surgery. It
is a slow-growing, round, firm, superficial or subcutaneous
lesion containing keratin

42. Cystic lesions
Sebaceous cyst is caused by a blocked pilosebaceous
follicle and contains sebaceous secretions; the gland orifice
will often be visible. It is only rarely found on the
eyelid although it may occasionally occur at the inner
canthus lesion containing keratin

43. Cystic lesions
Sebaceous cyst

44. Cystic lesions
Dermoid cyst is usually subcutaneous or deeper and is
typically attached to the periosteum at the lateral end of the
brow . It is caused by skin sequestered during
embryonic development

45. Cystic lesions
Dermoid cyst

46. Cystic lesions
Traumatic hematomatous cyst

47. Inflammatory lesions
Pyogenic granuloma is a rapidly growing vascularized proliferation of granulation tissue that is usually antedated by surgery,
trauma or infection, although some cases are idiopathic.

48. Inflammatory lesions
chalazion (meibomian cyst) is a sterile chronic granulomatous
inflammatory lesion ( of the meibomian, or sometimes Zeis, glands caused by retained sebaceous secretions.

49. Miscellaneous lesions
Xanthelasma is a common, frequently
bilateral condition typically affecting middle-aged and elderly
individuals. It is a subtype of xanthoma. Hyperlipidaemia is found
in about one-third of patients

50. References
• Diagnostic atlas of common eyelid diseases/Jonathan J. Dutton,Gregg S. Gayre, Alan D. Proia 2007
• Eyelid Tumors Clinical Diagnosis and Surgical Treatment Second Edition/Jay JustinOlder, Richard J Grostern 2003
• Clinical Evaluation and Reconstruction Techniques/ Frank Nesi 2014
• Kanski's Clinical Ophthalmology 8th 2016