The skin of the eyelids is a common site for benign and malignant growths.
Xanthelasma is a common, benign deposit of yellow-white flat plaques of lipid material that occur subcutaneously on the upper and lower eyelids. Although some people with xanthelasmas have dyslipidemias Dyslipidemia Dyslipidemia is elevation of plasma cholesterol, triglycerides (TGs), or both, or a low high-density lipoprotein cholesterol (HDL-C) level that contributes to the development of atherosclerosis... read more , most do not. Diagnosis is by appearance. No treatment is necessary, although xanthelasmas can be removed for cosmetic reasons, and underlying dyslipidemias should be treated.
Basal cell carcinoma
Basal cell carcinoma Basal Cell Carcinoma Basal cell carcinoma is a superficial, slowly growing papule or nodule that derives from certain epidermal cells. Basal cell carcinomas arise from keratinocytes near the basal layer, which are... read more frequently occurs at the eyelid margins and classically is associated with loss of eyelashes as shown, at the inner canthus, and on the upper cheek. Metastasis is rare. Biopsy establishes the diagnosis.
Treatment is surgical excision using conventional techniques or by Mohs surgery. For locally advanced or metastatic basal cell carcinoma, treatment with small-molecule inhibitors of the Hedgehog signaling pathway (eg, vismodegib or sonidegib) show promise to avoid resection of the globe (1 General reference The skin of the eyelids is a common site for benign and malignant growths. A xanthelasma is a slightly raised, yellow-white, well-circumscribed plaque that typically appears along the nasal... read more ).
Other malignant growths
Other types of malignant growths are less common; they include squamous cell carcinoma Squamous Cell Carcinoma Squamous cell carcinoma is a malignant tumor of epidermal keratinocytes that invades the dermis; this cancer usually occurs in sun-exposed areas. Local destruction may be extensive, and metastases... read more , sebaceous gland carcinoma, and melanoma Melanoma Malignant melanoma arises from melanocytes in a pigmented area (eg, skin, mucous membranes, eyes, or central nervous system). Metastasis is correlated with depth of dermal invasion. With metastasis... read more . Eyelid growths may simulate chronic blepharitis Chronic blepharitis Blepharitis is inflammation of the eyelid margins that may be acute or chronic. Symptoms and signs include itching and burning of the eyelid margins with redness and edema. Diagnosis is by history... read more or chronic chalazion Chalazion and Hordeolum (Stye) Chalazia and hordeola (styes) are sudden-onset localized swellings of the eyelid. A chalazion is caused by noninfectious meibomian gland occlusion, whereas a hordeolum usually is caused by infection... read more . Therefore, chronic blepharitis, chronic chalazion, or similar lesions should be biopsied if the patient is unresponsive to initial treatment.
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