The Ophthalmic Office Procedures Handbook



Eyelid Biopsy

or when the patient’s hormones have changed quickly. Benign lesions can start to accumulate pigment and become darker with age. It is recommended that any lesion that is suspicious be sent in formalin to a pathology laboratory along with clinical information for histopathologic identification. The patient needs to be aware that there may be a pathology processing fee as well as a pathologist charge for reading the specimen. Medicare and most insurances will pay these fees. Some insurances require precertification before removing a lesion in the office. Check with the patient’s insurance provider to be sure. The anatomical position of the eyelid lesion will dictate the best approach for the examiner to proceed. The three main areas are lid margin (Figure 7-1), lash line (Figure 7-2), and periocular lid lesions (not involving the lash line or lashes) (Figure 7-3A and B). Lid lesion biopsies can be divided into excisional, shave or incisional, and punch biopsy . Excisional biopsy involves removing the whole lesion completely. Incisional biopsy involves removing some of the lesions, leaving tumor or abnormal cells behind. If the lesion is being cut flush with the surrounding remaining skin, that is a shave biopsy. The clinician is aware that some cells of the lesion are most likely still present to avoid causing a defect in the lid or excessive loss of lashes. A punch biopsy can be either an excisional or incisional biopsy, depending on the size of the lesion and the punch diameter and size. The decision to do an excisional, incisional, shave, or punch biopsy depends on the location and size of the area to be biopsied and the level of concern for malignancy.

FIGURE 7-1 Lid margin lesion. The patient noticed that the lesion has grown since she has been pregnant. Diagnosis is most likely con genital nevus, changing because of hormonal changes. If she wants it removed, recommendation would be a shave biopsy with possible use of a chalazion clamp. This should be performed after the patient has delivered and is no longer nursing. It might return over many years, but the clinician should avoid leaving a noticeable notch or divot in the eyelid margin.

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