A lot of tumour can localize on the eyelids and be a source of great worry for the patient because of both the aesthetic implications and their interference with mechanical function and sight. Moreover benign neoplasms can be a manifestation of systemic diseases. Benign neoplasms. The most common lesion is seborrheic keratosis. Palpebral syringoma or hidroadenoma, a tumour of the eccrine ducts, often appears with multiple lesions especially on and near the lower eyelid. Nodular appendage tumours with differentiation towards hair such as trichoepithelioma, trichilemmoma and pilomatricoma may occasionally involve the eyelids; the differential diagnosis is difficult and need a histological examination. Eccrine or apocrine hydrocystomas appear as papulo-nodular lesions on the rim of the eyelid. Melanocytic naevi are occasionally present on the eyelid, the conjunctiva or the sclera. A peculiar congenital melanocytic nevus located on both the superior and inferior eyelid is naevus disjunctus. The unilateral Ota nevus is a dermic melanocytosis of the face which follows the area of the trigeminus innervation and frequently involves the ocular structures. Among hemangiomas, the cavernous form, when affecting the eyelids, can cause damages also to the eyeball and must be treated by local and systemic steroids, embolisation and laser therapy. Xanthelasma, in the form of elongated, yellowish patches, occurs selectively on the eyelids; it may be associated with familiar hypercholesterolemy and can be removed in different ways for aesthetic reasons. Malignant tumours. Basal cell carcinoma (BCC) and sebaceous carcinoma (SebC) frequently arise in the eyelid, whereas solar keratosis (SC), squamous cell carcinoma (SqC) and lentigo maligna melanoma (LMM), all of them chronic sun damage-related, less frequently primitively affect the eyelids because the upper one is in a more retracted position while and the lower one is hit by sun's rays at a very oblique angle. These neoplasms can, on the other hand, extend to the eyelid starting from a primitive location in the periocular region. The BCC constitutes 80-95% of malignant tumours of the eyelid and in 70% of cases is situated in the lower lid and medial cantus. It gradually enlarges destroying adjacent structures. Very rarely it spreads to regional nodes. Surgery is the best treatment; sometimes it is very difficult to achieve a complete cure because the borders are difficult to appreciate. Roentgentherapy is of value in selected cases, although not for the fibrosing variant. SqC is the second most common tumour of the eyelid region (around 9%). It generally originates from a precancerous state such as solar keratos is. Metastasis is relatively frequent to regional nodes. Again, surgery is the best treatment, and in some cases also roetgentherapy. SebC occurs in the eyelids in 75% of cases from Meibonian glands, glands of rim or caruncola, or indeterminate sites. It particularly affects the upper eyelids and frequently takes the appearance of a chalazion, a BCC, a blepharitis or other inflammatory diseases. If not diagnosed early, it runs an aggressive course with frequent regional and distant metastasis. MM rarely occurs on the eyelids: It only represents 0.2-0.4% of malignant lesions. The prognosis is worse when the neoplasm involves the rim of the eyelid and the conjunctiva. Lentigo maligna (LM) is a superficial spreading MM in chronically damaged skin such as the face; before becoming invasive it slowly extends in many years possibly affecting the eyelids. Given the aesthetic and functional importance of the eyelids, any neoplasm in such area must be diagnosed and eradicated as quickly as possible to ensure the best functional and aesthetic results.
|Title of host publication||Journal of Plastic Dermatology|
|Number of pages||10|
|Publication status||Published - Jan 2006|
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