Papilloma Eyelid: Types, Symptoms and Treatments

The word "papilloma" describes a variety of ¹benign epithelial proliferation that may affect the skin of the eyelids. The papillomavirus is not always linked to these lesions.

Although these lesions are not harmful, they may produce moderate discomfort or harm the patient's appearance.

This exercise highlights the function of the interprofessional team in managing eyelid papillomas while describing their aetiology and pathogenesis.

Even though the eyelid only has a modest surface area, it is crucial for safeguarding the eyeball. The eyelid skin is the thinnest in the body and lacks subcutaneous fat.

The eyelids are especially vulnerable to irritants and UV damage due to these qualities and their placement on the body.

As a result, benign and malignant eyelid tumours are more likely to grow on eyelids. According to one research, between 5 and 10 per cent of all skin malignancies affect the eyelids.

The word "papilloma" describes a variety of benign epithelial proliferations that may affect the skin of the eyelids. The papillomavirus is not always linked to these lesions.

Although these lesions are not harmful, they may produce moderate discomfort or harm the patient's appearance. Additionally, it's critical to be able to distinguish a possibly cancerous tumour on the eyelid from a benign lesion like a papilloma.

Seborrheic keratosis, pseudoepitheliomatous hyperplasia, inverted follicular keratosis, verruca vulgaris, squamous papilloma (acrochordon/skin tag), basosquamous acanthoma, and squamous acanthoma are only a few of the lesions that come under this group.

Some types of papillomas are described below.

Squamous papilloma

Another name for a squamous papilloma is an acrochordon or a skin tag. This is a smooth, spherical, and/or pedunculated lesion that is soft and flesh-coloured.

Seborrheic keratosis

This cell multiplication is healthy. Traditionally has a "stuck-on" effect and may be pigmented to different degrees.

Lesions often range in hue from pink or flesh to dark brown. These lesions are generally somewhat raised and well-circumscribed.

The abrupt emergence of several ²seborrheic keratoses in one area of the body might point to a paraneoplastic development even though these lesions are typically benign.

The base of these tumours is often irritated. The Leser-Trelat sign is what it is.

Pseudoepitheliomatous Hyperplasia

These lesions, which might resemble basal cell or squamous cell carcinoma, are often reactive processes in reaction to trauma, wound, burn, pharmacological substances, etc. These lesions often have an uneven surface, are raised on the skin, and may sometimes include ulceration or crusting.

Inverted Follicular Keratosis

This is normally a solitary lesion affecting the eyelid margin. It may or may not be pigmented and has been described as either nodular or papillary in appearance.

Verruca Vulgaris

This human papillomavirus-induced skin growth is flesh-coloured. On the eyelid, this lesion is uncommon.

Etiology

The kind of epithelial proliferation affects the aetiology of papillary lesions. Seborrheic keratosis and squamous papillomas are idiopathic cases of benign cellular growth.

These lesions have no recognised clear-cut etiology. However, persistent UV exposure and sun-damaged skin are often linked to malignant skin lesions that might resemble papillomas. Human papillomavirus is the root cause of verruca vulgaris.

Epidemiology

According to one research, the majority of eyelid cancers are epidermal tumours.

In one research, seborrheic keratosis and squamous cell papilloma were reported to be the two lesions that were most commonly identified.

Squamous papillomas are the most prevalent benign epithelial tumour of the eyelid, according to different research. 

The majority of individuals with seborrheic keratosis are middle-aged or older.

Squamous papillomas don't show a clear preference for any one race or gender. They may happen at any age, although their frequency seems to rise with advancing years.

Histopathology

On histological preparation, seborrheic keratosis exhibits hyperkeratosis, acanthosis, and some degree of papillomatosis.

The squamous cells that make up the lesion are not dysplastic by definition. Pseudo-horn cysts are a common occurrence in certain cases of seborrheic keratosis.

In the acanthotic epithelium of the seborrheic keratosis lesion, there are these circular clumps of surface keratin.

Benign squamous epithelium with varying degrees of acanthosis, hyperkeratosis, and isolated parakeratosis overlaying a fibrovascular core is seen in squamous papillomas.

It has been shown that they may sometimes exhibit signs of persistent inflammation.

Pseudoepitheliomatous hyperplasia exhibits invasive, protracted hyperplastic epithelial processes and often contains inflammatory cells; nonetheless, malignancy-indicating features such as dysplasia and aberrant mitoses are not present. 

Endophytic basal and squamous element growth is seen in inverted follicular keratoses. These lesions may exhibit persistent inflammation, acantholysis, and pigmentation.

Treatment of papilloma eyelid 

It is possible to see lesions that turn out to be eyelid papillomas. It is possible to eliminate papillomas if they are irritating the patient or are unattractive on the aesthetic front.

A bedside shave excision may be used to eliminate the majority of papillomas. see the procedure outlined below. Cryotherapy often had greater results for verruca Vulgaris.

In one trial, a big eyelid papilloma was effectively treated with intralesional interferon.

A bigger trial with 64 individuals who had lesions that resembled eyelid papillomas discovered that employing a radiofrequency device for lesion excision was secure and efficient.

Squamous papillomas made up 72% of the lesions in this research that were treated.

Papilloma Excision Technique

To stop eye discomfort from the cleaning solution, use a topical tetracaine drop in the opposite eye. To clean the papilloma region and the tissue around it on the eyelids, use full strength povidone-iodine solution. To isolate the eyelid lesion, use a tiny, sterile drape with a hole cut out of it.

Under the papilloma, inject 1 to 2 mL of lidocaine with epinephrine. As little local anaesthetic as possible is used to ensure the patient is comfortable enough.

When removing the lesion, carefully lift the tissue while holding a 15-blade or iris scissor in place. For complete removal, start your cutting at the lesion's base. No need to access deeper tissues should exist.

To stop bleeding, a portable cautery instrument may be used. Most of the time, the residual defect is little and may be approximated by the skin without the need for sutures.

Erythromycin ophthalmic ointment, a prescribed antibiotic, is to be applied to the healing incision by the patient three to four times per day for one to two weeks, or until it is healed, in order to avoid infection.

If there are any questionable traits, think about submitting a tissue sample to pathology for analysis.

Differential Diagnosis

Chalazion/hordeolum, epidermal inclusion cyst, molluscum contagiosum, xanthelasma, squamous cell carcinoma, nevus, actinic keratosis, basal cell carcinoma, and sebaceous gland cancer are a few examples of differential diagnoses.

Chalazion/hordeolum, epidermal inclusion cyst, molluscum contagiosum, xanthelasma, squamous cell carcinoma, nevus, actinic keratosis, basal cell carcinoma, and sebaceous gland cancer are a few examples of differential diagnoses.

Conclusion:

The emergency room doctor, primary care physician, internist, or nurse practitioner may be the ones who first notice lesions on the eyelid.

Because the general practitioner is often not knowledgeable about the anatomy or surgical principles of eyelid surgery, it is crucial to send these patients to an ophthalmologist.

The form of therapy depends on the size of the lesion, neighbouring spread, and involvement of other organs. Lesions on the eyelid may be benign or malignant.

Additional resources and citations

• 1
  benign epithelial
• 2
  seborrheic keratoses