The most common benign eyelid lesions are hyperplastic growths arising from the epidermis. There is considerable overlap of both clinical and histopathologic characterizations of these various benign epithelial proliferations. The epithelial hyperplasia group includes fibroepithelial polyps (synonymous with squamous papillomas, skin tags, and acrochordons), seborrheic keratoses, verrucae, squamous acanthomas, inverted follicular keratoses, baso-squamous acanthomas, squamous acanthomas, and many others. These superficial lesions can all be removed with shave excision at the dermal epidermal junction.
These growths (Figure 1) are very common, second only to squamous papillomas, and their incidence increases with age. Their clinical appearance is variable. They may present as sessile or pedunculated lesions, with or without pigmentation and hyperkeratosis. Seborrheic keratoses usually manifest as flat, “greasy,” “stuck-on” lesions. However, they are often more lobulated or pedunculated on the thin eyelid skin. Nearly all seborrheic keratoses remain totally superficial and can be completely excised by shaving or excising the lesion at the dermal-epidermal junction with a scalpel. The flat excision site does not require sutures and re-epithelializes rapidly.
These growths (Figure 2) are usually caused by epidermal infection with the human papilloma virus (type VI or XI). Although these growths are less common on the eyelids, they are typically located near the lid margins. Treatment options include simple excision or cryotherapy.
A cutaneous horn (Figure 3) is a structurally descriptive term representing exuberant hyperkeratosis. This neoplasm may grow rapidly or very slowly and can be caused by various underlying benign or malignant etiologies, including seborrheic keratosis, verruca vulgaris, squamous cell carcinoma, or basal cell carcinoma. Histopathologic examination of the base of the cutaneous horn lesion is necessary to establish the definitive diagnosis, as the elongated region of hyperkeratosis is nondiagnostic.