The Ophthalmic Office Procedures Handbook

7 Eyelid Biopsy

Scott C. Sigler

One of the most overlooked sections of the eight-part eye exam is the external examination. The external exam consists of evaluation of the face and periocular area: paying close attention to the lid position, lash line, and globe position, and noting any unusual lesions or growths on the lids. Proptosis, face palsy, dermatochalasis, lagophthalmos, and brow ptosis should be noted, as well as lid malposition like ptosis, ectropion, and entropion. If a lid lesion is iden tified and the decision is made for excisional or incisional biopsy, the examiner needs to be comfortable in performing this procedure. Lid lesions are very common, especially in the older population. Fortunately, 85% to 90% of eyelid lesions are benign. They can be unsightly, but rarely uncomfortable. If large, they can cause lid malposition or obstruction in the visual field. The examining clinician should be aware of the characteristics seen in malignant tumors. A patient’s history may also cause a clini cian to be more suspicious for skin cancer. Some of the most significant signs and symptoms of eyelid lesion malignancy are: ● Loss of lashes associated with the lesion ● Distorted architecture of the lid ● Increased or changing pigmentation ● White, pearly surface ● Ulcerated center ● History of bleeding from the lesion ● History of chronic blepharitis/conjunctivitis on one side only ● Any history of skin cancer of the face or lids A patient may request a lesion to be removed. This may be due to the appearance of the le sion, interference with makeup, itching or bleeding, or obstructing the patient’s vision or visual field. Some patients may present with a concern that the lesion is a skin cancer. The examiner may recommend a lesion be removed due to a concern for possible malignancy. No clini cian can tell for sure whether a lesion is benign or malignant without a histopathologic examination under the microscope to identify the lesion and cells. Many a clinician has been wrong about the nature of a skin lesion in the past. Both benign and malignant lesions are usually slow growing. However, there are some lesions like seborrheic keratosis, cysts, and papillomas that have a distinct appearance under the slit lamp, and the patient can be assured the lesion is benign. Congenital nevi of the lid can grow rapidly during puberty, pregnancy,

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