This document provides information on various benign and malignant skin tumors that can occur on the eyelids. It describes seven common benign tumors (papillomas, xanthelasma, hemangioma, neurofibroma, keratoacanthoma, naevi, dermoid cyst) and their characteristic appearances and typical management. It also discusses two pre-malignant conditions - actinic keratosis and xeroderma pigmentosa - that can potentially develop into skin cancers on sun exposed areas like the eyelids.

1. -10M2368

2. CLASSIFICATION
BbBBRBBENIBRRBENIGN MALIGNANTPRE-MALIGNANT

3. I. PAPILLOMAS
II. XANTHELASMA
III. HEMANGIOMA
IV. NEURFIBROMA
V. KERATOACANTHOMA
VI. NAEVI
VII. DERMOID CYST

4.  Most common benign tumors arising from
the surface epithelium.
 Occurs in two forms
>Squamous cell Papilloma
>Basal cell Papilloma
[ Seborrhoeic Keratosis]

5.  Outgrowth of fibrovascular connective tissue covered by
irregular keratinized stratified squamous epithelium
 No predilection to race or gender
 Appearance
 Variable presentations
 “Skin tag” type: narrow base, pedunculated, skin colored
 Board base with “raspberry like” appearance
 Differentiate from viral wart (human papilloma virus)
 Management
 Removed by excision

6. PEDUNCULATED
SESSILE

7.  Expansion of the squamous epithelium stemming from
basal cell proliferation
 Common in the elderly
 Usually develop on the head, neck, or trunk
 Appearance
 Round “coin-like” lesion with “stuck-on” appearance
 Up to 2.5 cm diameter
 Slightly raised and crusty; surface is friable, verrucous
and slightly pigmented (Tan to dark brown in color)
 Variety of textures: granular to velvety
 Management
 No treatment required except for cosmetic reasons or if
they become irritated
 Removed by excision

9. Aggregation of lipid filled macrophages at the level of the
dermis
 Common and frequently bilateral.
 Middle aged and the elderly.
 Associated with elevated cholesterol especially when
occurring in younger individuals with Arcus senilis.
 Appearance
 Yellowish subcutaneous plaque
 Usually on the medial portion of the eyelids
 Often multiple
 Management
 Removed for cosmetic reasons
 Usually excised with carbon dioxide or argon laser
 Recurrence suggests persistently elevated cholesterol

10. Appearance:
>Yellowish subcutaneous
plaque
>Usually on the medial
portion of the eyelids
>Often multiple

11.  Hemangiomas of the lids are common tumors.
 Occurs in three forms:
1. Capillary hemangioma.
2. Naevus flammeus(Port-wine stain).
3. Cavernous hemangioma.

12.  Most common variety.
 Occurs at/shortly after birth and grows rapidly.
 APPEARANCE: Superficial, bright red in colour (strawberry
naevus) / deep bluish / violet in colour.
: consist of proliferating capillaries and
endothelial cells.
 TREATMENT:
Resolves spontaneously by the age of 7 yrs.
Excision for small tumors.
Intralesional steroid( Triamcinolone)
Alternate day high dose steroid therapy & Superficial
Radiotherapy.

13. Starts as small, red
lesion,
most frequently on
upper lid
Blanches with pressure
and swells on crying

14. • May occur commonly in Sturge-
Weber syndrome.( associated
with port-wine stains of the
face, glaucoma, seizures, mental
retardation)
• Consists of dilated vascular
channels
• Does not regress like capillary
hemanigioma
• LASER TREATMENT:

15.  Occurs after first decade of
life
 commonly present as solitary,
unilateral lesions
 Consists of large endothelium
lined vascular channels
 Does not show any regression
 TREATMENT:

16.  Rare and often rapid growing lesion arising from a hair
follicle
 Typically older males
 Appearance
 Non pigmented papilloma at the lid margin
 Up to 1 cm diameter
 Histologically similar to basal cell papilloma, but with
deeper extension into the dermis
 Management
 Deep excision
 Recurrence is common if not completely removed

18.  Abnormal proliferation of Schwann cells, fibroblasts, and
axons
 Solitary lesions occur in adults
 25% associated with neurofibromatosis-1
 Children with neurofibromatosis-1 are affected by diffuse
lesions
 Appearance
 Characteristic S shaped lesion
 Typically located on the upper lid
 Management
 Solitary lesions removed by excision
 Diffuse lesions are more difficult to
 remove

19.  Rare and rapidly growing variant of actinic keratosis
Higher occurrence in patients on immunosuppressive
therapy following kidney transplants
 Appearance
 Initially appears as a pink hyperkeratotic lesion usually on
the lower lid
 After a period of rapid growth, remains stable for several
months
 Then begins to involute and a keratin filled crater often
forms
 Complete involution can occur after a year leaving a
residual scar
 Management
 Usually excised with cryotherapy or radiotherapy

21. Tumor composed of cells derived from arrested epidermal
melanocytes
 Acquired and congenital forms
 TYPES: Junctional type occurs in the young
Compound type occurs in middle age
Intradermal type most common and occurs in
the elderly
 Management
 Removal for cosmetic reasons or if malignancy is
suspected
 Excision may need to be followed by reconstruction
depending on location and size

22. Junctional Nevus:: Uniform brown
macule or plaque
Compound Nevus:Uniform, light to dark
brown, raised papule
Intradermal Nevus:: Papillomatous with
little to no pigment. Associated with
dilated vessels and protruding lashes

23.  A dermoid is an overgrowth of normal, non-
cancerous tissue in an abnormal location.
 There are two main types:
 orbital dermoid is typically found in
association with the bones of the eye socket.
 epibulbar dermoid is found on the surface of
the eye, either at the junction of the cornea
and sclera (limbal epibulbar dermoid) or
posteriorly on the eye (posterior epibulbar
dermoid or lipodermoid).

25.  ACTINIC KERATOSIS
 XERODERMA PIGMENTOSA

26.  DEFINITION: Slow growing keratinization of the
epithelium from excessive sun exposure
 May transform into squamous cell carcinoma
 Elderly individuals with lightly pigmented skin
 Rarely develops on the eyelid
 Common on the scalp, ears, forehead, and backs of
hands
 Appearance
 Rough, dry, and scaly plaque that is flat or slightly
raised, distinct boarders
 Often multiple lesions in a single area that coalesce
 May be skin colored to dark brown

28.  Autosomal recessive disease
 Damage on exposure to sunlight
 Characterstic features
Progressive cutaneous pigmentation
Bird-like facies is typical.
 Predisposition to develop lid
tumors