Seborrheic keratosis is one of the most frequently noted benign eyelid tumors.
Unlike squamous carcinomas of the eyelid, seborrheic keratosis does not typically cause inflammation around its edges nor does it have a smooth reddened scaly surface. If it does become inflamed it can be mistaken for a basal or squamous cell carcinoma.
Typical appearing seborrheic keratosis can be photographed and followed for evidence of change prior to consideration of biopsy or removal. Suspicious seborrheic keratosis can be differentiated from other eyelid tumors by a simple biopsy.
Seborrheic keratosis does not require treatment. Photography should be used to document its initial size for future reference and comparison. Suspicious lesions should be biopsied or removed to differentiate them from malignant eyelid tumors.
Note its “stuck-on” appearance, its cobblestone surface, well-defined margins and lack of inflammation. Histopathology reveals a hyperkeratotic tumor consisting of a basaloid proliferation with keratin cysts.
Congenital “strawberry-spot” which usually will spontaneously get smaller “involute.”
Treatment is indicated for the prevention of amblyopia (loss of vision) and strabismus (misdirected eyes). These tumors naturally grow and then spontaneously decrease in size. Therefore, if the tumor is not harming the child, it can be observed untreated for spontaneous regression.
Capillary hemangiomas are typically found at birth. They will grow during the first decade (10 years) and most will shrink (involute). If they involve the eyelids, they can cover the eye and cause loss of vision (amblyopia). It is very important that children with capillary hemangiomas be seen by a pediatric ophthalmologist and eye cancer specialist immediately.
Capillary hemangioma is diagnosed by clinical examination. It has a typical appearance and biopsy is rarely needed. It appears as a reddish tumor or mass beneath the skin. The eye care specialist will order a radiographic scan (MRI or CT) to see how deep the tumor extends into the orbit (around the eye). The child’s pediatrician should be advised and the child inspected for hemangiomas on other parts of the body.
Observation for spontaneous resolution is commonly performed. If the tumor is blocking the eye and vision causing amblyopia, then it can be treated with an oral beta-blocker medication (e.g. propranolol) or injected with a steroid solution. This will shrink the tumor in an effort to uncover the eye. Surgery may be required to remove very large tumors. The child’s pediatric ophthalmologist may suggest that the other “good” eye be periodically covered with a patch to strengthen the tumor affected eye and prevent amblyopia-related vision loss.
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