Eyelid Lesions Research Articles

A pilot study on the efficacy of 10600 nm carbon dioxide laser ablation in treatment of eyelid margin lesions

Objectives: Eyelid margin lesions cause discomfort by impeding both central and peripheral vision, depending on their position on the eyelids, thus hindering everyday routines. However, surgical excision, radiofrequency, electrocautery, and cryosurgery are employed for treatment, although they are complicated and have functional limitations. Carbon dioxide (CO2) lasers were used to assess the efficacy, safety, and patient satisfaction with CO2 laser ablation in managing eyelid margin lesions. Material and Methods: This is a pilot study of patients with eyelid margin lesions presented to a private clinic in urban Gujarat between June 2020 and June 2023. All patients were treated with a 10600 nm CO2 laser with a power of 1–2 W in continuous mode. The eyelid lesions were classified into three categories based on their size: Small (1–3 mm), medium (4–6 mm), and large (7–10 mm). The clinical response was assessed by the treating physician at week 1 and week 4, and categorized as excellent (complete clearance of lesion), moderate (>50%), or poor (<50%). Patients were asked to rate their level of satisfaction on a three-point scale at the end of the follow-up period: Dissatisfied, somewhat satisfied, or very satisfied. Results: Ten patients of all females with six of them having compound melanocytic nevi, two of them each had cystic hidradenoma, and one each had cyst of zeis and verruca vulgaris. Six of them had small lesions, two had medium, and two had large lesions. The clinical response grading of physicians at both 1 week and 4 weeks was excellent, and the patient satisfaction questionnaire yielded excellent outcomes. Conclusion: The ablative CO2 laser is an excellent device used for the treatment of eyelid margin lesions, particularly when performed by an expert and skilled dermatologist. The application of this treatment approach has proven to be very beneficial and shows excellent results in terms of both the esthetic appearance and structural function of the eyelids.

Association of benign and malignant neoplastic lesions of the eyelid with systemic inflammatory markers

ABSTRACT Clinical relevance The role and prognostic significance of systemic inflammatory markers in various malignancies have been the subject of investigation. The role of these inflammatory markers in eyelid lesions remains to be elucidated. Background Benign and malignant lesions of the eyelid are common presentations in eye clinics. Systemic inflammatory markers derived from a complete blood count may provide insight into the benign-malignant differentiation of the lesion. Methods This study included 134 patients who underwent surgery for eyelid lesions between 2021–2023. The lesions were evaluated by oculoplastic surgeons and operated on with a preliminary diagnosis of benign or malignant. According to the histopathological diagnosis, benign lesions were included in Group 1 and malignant lesions in Group 2. The neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and systemic immune inflammation index (SII) (NxP/L) based on neutrophil, lymphocyte, and platelet counts were calculated from the preoperative complete blood count of all patients. Results Eighty-eight patients were included in Group 1 and 46 patients in Group 2. There were 41/47 (Female/Male) in Group 1 and 19/27 (F/M) males in Group 2 (p = 0.345). The mean age was 62.91 ± 9.04 years in Group 1 and 65.41 ± 8.76 years in Group 2 (p = 0.127). The preliminary diagnosis and histopathological diagnosis were incompatible in 5 cases in both groups. In Group 1: NLR = 1.82 ± 0.72, PLR = 124.50 ± 45.19 and SII = 454.51 ± 220.20, in Group 2: NLR = 2.48 ± 0.89, PLR = 128.12 ± 49.58 and SII = 590.22 ± 271.09. NLR and SII differences between groups were statistically significant, while PLR was similar (p < 0.001, p = .002, p = .671). ROC curve analysis showed that the optimal cut-off values for NLR, PLR, and SII were 1.99, 119.16, and 475.21, respectively. Conclusion High levels of NLR and SII in eyelid tumours can be used as an adjunct to examination findings in the preliminary diagnosis of the lesion as benign or malignant and may influence surgical planning.

A case of adnexal cutaneous leishmaniasis in Washington DC

PurposeTo report a rare non-endemic case of Leishmania aethiopica in Washington DC.Case reportA 68-year-old female presented for a routine examination with a complaint of right upper eyelid lesions for the past 5 months. On examination, a cluster of elevated and erythematous lesions extending from the medial canthus to the brow area of the right eye were seen. Initial treatment with Valtrex based on a suspected viral etiology failed. Although a biopsy was recommended at this time, the patient declined, and subsequent workup included nasolacrimal duct irrigation, blood work to rule out autoimmune etiology, a course of doxycycline, and an MRI, which yielded no improvement. Upon progression of the lesions into persistent plaques on the eyelids, a punch biopsy was performed, confirming leishmaniasis. The patient was then started on a 28-day course of oral miltefosine which led to complete resolution of her symptoms.ConclusionThis case underlines the importance of a broad differential including non-endemic diseases, particularly in urban areas with frequent patient travel. Furthermore, the delayed punch biopsy in this case highlights the importance of patient counseling to ensure prompt diagnosis and treatment.

A jugular venous compression adjunct for surgical excision of distensible orbital venous malformations

ABSTRACT Purpose Orbital venous malformations (VM) pose challenges in complete resection due to indistinct borders and bleeding proclivity. Current methods for aiding surgical excision of distensible orbital venous malformations are inadequate. We investigated whether external neck compression could facilitate intraoperative distension of venous orbital lesions during surgical excision in patients diagnosed with VM. Methods Eighteen patients (8 males and 10 females) diagnosed with distensible venous anomalies were enrolled. Neck compression technology, was employed to distend the lesions before puncture embolization using n-butyl-2-cyanoacrylate glue under general anesthesia. The surgical process, along with preoperative to postoperative changes in ocular symptoms, were recorded. Results The average surgical duration was 95 min. A mean of 3.41 ml surgical glue was used for embolization. The compression belt maintained pressure at 35–40 mmHg. Total lesion resection was achieved in 12 patients, with 6 patients undergoing subtotal removal not requiring supplementary surgery. Symptoms were entirely alleviated in 17 patients, and signs of distensible lesions during the Valsalva maneuver were absent. One patient underwent secondary surgery for residual eyelid lesions. Minor complications included mild ocular movement restriction, residual subcutaneous induration, transiently increased orbital pressure, and lower lid ectropion in four, three, four, and one patient, respectively. Three patients experienced a mild post-operative visual acuity decrease, although none experienced vision loss. Conclusions Direct orbital embolization aided by a jugular vein compression device is safe and demonstrates satisfactory outcomes in orbital varicose vein treatment.

Population-Based Incidence and Clinical Characteristics of Ocular Adnexal Tumors in Olmsted County, Minnesota

ABSTRACT Purpose To determine the incidence and clinical characteristics of ocular adnexaltumors in Olmsted County, Minnesota. Methods Retrospective population-based cohort study of all patients residing in Olmsted County, Minnesota diagnosed with any ocular tumor from January 1, 2006, to December 31, 2015. The medical records of all patients with an incident diagnosis of any ocular adnexal tumor were reviewed using the Rochester Epidemiology Project medical record linkage system for patient demographics, tumor type, and histopathologic confirmation. Incidence rates were calculated per 100,000 person-years. Poisson regression analysis was used to analyze changes in incidence over time. Results There were 717 patients diagnosed with ocular adnexal tumors during the 10-year study period, yielding an age- and sex-adjusted incidence rate of 59.7 per 100,000 (95% CI 55.4 to 64.0, p < 0.05) per year. In total, 764 tumors were diagnosed. Most tumors were eyelid lesions (N = 756, 99.0%), which were mostly benign (N = 512, 67.8%) with epidermal inclusion cysts (N = 275, 36.0%), hidrocystoma (N = 70, 9.2%), and eyelid sebaceous cysts (N = 46, 6.1%) accounting for the majority. Malignant eyelid lesions (N = 244, 31.9%) were relatively common with basal cell carcinoma (N = 184, 24.1%) and squamous cell carcinoma (N = 49, 6.4%) having the highest frequencies. Orbital tumors (N = 8, 1.0%) were infrequent. Of the orbital tumors, the most common was lacrimal gland adenoidcystic carcinoma (N = 2, 25.0%). Conclusions In a population-based setting, most ocular adnexal tumors were benign eyelid lesions. Understanding the epidemiology of ocular adnexal tumors is important to aid providers in diagnosing and facilitating appropriate referrals of potentially vision- and life-threatening malignancies.

Computer-aided diagnosis of eyelid skin tumors using machine learning

ObjectiveTo develop an automated, new framework based on machine learning to diagnose malignant eyelid skin tumors. MethodsThis study used eyelid lesion images from Sheba Medical Center, a large tertiary center in Israel. Before model training, we pretrained our models on the International Skin Imaging Collaboration (ISIC) 2019 dataset consisting of 25,332 images. The proprietary eyelid data set was then used for fine-tuning. The data set contained multiple images per patient, aiming to classify malignant lesions in comparison to benign counterparts. ResultsThe analyzed data set consisted of images representing both benign and malignant eyelid lesions. For the benign category, a total of 373 images were sourced. By comparison, for the malignant category, 186 images were sourced. For the final model, at sensitivity of 93.8% (95% CI 80.0–100.0%), the model has a corresponding specificity of 73.7% (95% CI 60.0–87.1%). To further understand the decision-making process of our model, we employed heatmap visualization techniques, specifically gradient-weighted Class Activation Mapping. DiscussionThis study introduces a dependable model-aided diagnostic technology for assessing eyelid skin lesions. The model demonstrated accuracy comparable to human evaluation, effectively determining whether a lesion raises a high suspicion of malignancy or is benign. Such a model has the potential to alleviate the burden on the health care system, particularly benefiting rural areas, and enhancing the efficiency of clinicians and overall health care.

Capillary hemangioma of the eye lid: A rare case in middle age adults

Abstract Capillary hemangiomas are the most common eyelid lesions seen in children, however, they are rare in middle-aged individuals. They can pose a diagnostic challenge in adults when they present as acquired lesions. We present a case of acquired lid capillary hemangioma in a 48-year-old female with no other predisposing risk factors and the management. In children, spontaneous resolution is a rule, whereas in adults because of the diagnostic dilemma excision biopsy remains the mainstay of management.

Facial vs Non-facial Molluscum Contagiosum Infection in Children: A Cross-sectional Study.

Molluscum contagiosum is a common skin infection affecting different body areas, including the face. Previous data have shown cases of atypical lesions, notably on the face, and it was thought relevant to further examine differences between facial and non-facial lesions. All cases of children (0-18) diagnosed with molluscum contagiosum from 2013-2022 at the paediatric dermatology clinic of Soroka University Medical Center were retrospectively reviewed, and 615 children were included in the study. Facial lesions tended to be found in younger children (p = 0.018). Non-facial lesions were more erythematous (p < 0.001), itchier (p < 0.001), and showed similar patterns of ulceration (p = 0.078) and purulence (p = 0.779). The average lesion diameter was similar in patients with or without facial lesions (p = 1). Children with facial lesions were treated differently from patients without facial lesions (p < 0.001); however, there were no differences in treatment response. This research challenges assumptions concerning the severity of facial lesions, including eyelid lesions, by revealing that, overall, they exhibit less inflammation than non-facial lesions. Despite the potential for greater psychosocial burdens and impacts on self-esteem associated with lesions on the sensitive facial area, this study provides evidence that they are not inherently more worrisome and can be managed similarly to lesions found elsewhere in the body.

A spectrofluorimetric method of testing a transplanted pedicle skin flap in eyelid neoplasm surgery

Purpose: to develop a method for assessing metabolic changes in pedicle skin flaps using spectrofluorimetry in eyelid neoplasm surgery. Material and methods. 14 patients (mean age 74.50 ± 7.14 years) were operated for eyelid neoplasms with tissue defects replaced by pedicle flaps. The area of eyelid lesion achieved 90 %. In 100 % of cases, a histological examination revealed basal cell carcinoma. Metabolic changes of the skin in the transplanted flap and in the symmetrical area of the fellow eye were assessed using the spectrofluorimetric method 3 days and 3 months after the surgery. A number of successive spectra of fluorimetric parameters were taken from each site, whereupon the mean values of the Metabolic Shift Index were calculated. Results. Differences in the spectrofluorimetric parameters of the metabolic shift between the area with the transplanted flap and the symmetrical area were revealed on the third day after surgery (p = 0.00058) and 3 months after it (p = 0.0317). The obtained results indicate a partial preservation of the hypoxic state of the skin on the third postoperative day and the complete restoration of trophism 3 months after the surgery (p = 0.043), as well as the onset of scarring of the transplanted flap by the latter time point. Conclusion. A technique for assessing metabolic changes in eyelid skin has been developed, which enabled the establishment of normal spectrofluorimetric values in this area and helped reveal the changes in the indices of metabolic shift in the transplanted pedicle flaps in the early postoperative periods and throughout the entire follow-up period. 3 months after the surgical treatment, the indices of metabolic changes in the transplanted pedicle flap come close to normal values.

Upper and Lower Eyelid Malignancies: Differences in Clinical Presentation, Metastasis, and Treatment.

Approximately 5-15% of all dermatologic malignancies manifest in the upper and lower eyelids. The primary types include basal cell carcinoma, squamous cell carcinoma, and sebaceous cell carcinoma, with Merkel cell carcinoma and melanoma following closely behind. Basal cell carcinoma predominantly affects the lower eyelid, yet various other carcinomas, melanomas, metastases, and neoplasms of diverse origins can arise on both upper and lower eyelids. Risk factors such as advanced age, smoking, and notably, exposure to UV light significantly contribute to the development of these eyelid lesions. Despite the increasing incidence, research on dermatologic eyelid malignancies remains limited. However, such study is imperative given that many systemic oncologic malignancies initially present as metastatic eyelid lesions. This paper provides an in-depth exploration of eyelid anatomy, clinical presentation, diagnosis, and treatment management.Key Points: Eyelid metastases represent less than one percent of all eyelid cancers, yet they often serve as the initial indication of an underlying systemic malignancy. Early detection and treatment is crucial in improving prognosis and quality of life for patients. Treatment options encompass a range of modalities, with Mohs surgery as the gold standard for the removal of ocular tumors. Additional treatment options include local excision as well as non-surgical interventions such as radiotherapy, cryotherapy, immunotherapy, and topical medications.

Dermoscopy can be safely and reliably used in ophthalmology

ObjectiveTo determine if dermoscopy, a technique widely utilized in dermatology for improved diagnosis of skin lesions, can be used comfortably for evaluating periorbital, eyelid, and conjunctival lesions. DesignProof-of-concept study in which a technique for performing dermoscopy near the eye was developed, related educational material was prepared, and a protocol for dermoscopic image capture was created. MethodsTechnicians used the developed materials to learn to take high-quality pictures with a 10x dermoscope attached to a standard cell phone camera. The images were assessed for diagnostic utility by an oculoplastic surgeon and two dermatologists. Participants115 patients recruited from ophthalmology clinics from July 2021 to April 2023 were photographed, yielding 129 lesions with high-quality dermoscopic images as assessed by an oculoplastic surgeon and two dermatologists. ResultsTechnicians reported a significant increase in confidence (measured on a 1–10 scale) with dermoscopy after training (pre-instruction mean = 1.72, median = 1, mode = 1, IQR = 1.25 vs mean = 7.69, median = 7.75, mode = 7 and 8, IQR = 1.5 post-instruction. Wilcoxon rank sum test with continuity correction, W = 0, p < 0.001, paired t = 13.95, p < 0.0001). Incorporating a contact plate with a 4 × 4mm reticule on the dermoscope aided in photographing ocular and periocular lesions. ConclusionMedical support staff in eye-care offices can be taught to use dermoscopes to capture high-quality images of periorbital, eyelid, and conjunctival lesions. Dermoscopy illuminates diagnostic features of lesions and thus offers a new avenue to improve decision-making in ophthalmology. Dermoscopy can be incorporated into telemedicine evaluations by ophthalmologists, oculoplastic surgeons, or affiliated dermatologists for triage of or rendering advice to patients and for planning of surgery if needed.

Congenital solitary osseous choristoma of the left lateral canthus: a case report

BackgroundAn ocular osseous choristoma is a growth of mature, compact bone in the ocular or periocular soft tissue, and it is the rarest form of ocular choristoma, accounting for only 1.7% of all epibulbar choristomas.Case presentationHerein we present the case of a 20-month-old girl who was referred to the oculoplasty clinic with a progressively growing mass in the left lateral canthus. It had been present since birth without ocular involvement. Upon examination the mass was firm with a smooth surface, measured 9 × 6 × 3 mm, and exhibited no episcleral attachment or ocular involvement. An excisional biopsy was performed, and the histopathological findings were consistent with osseous choristoma of the left lateral canthus.ConclusionsThis report highlights the importance of considering osseous choristoma in the differential diagnosis of eyelid lesions, particularly those that have been present since birth. It also emphasizes the need for further studies investigating associations between osseous choristomas and ocular canthi.

Clinicopathological study of ophthalmic cutaneous and mucocutaneous non-langerhans cell histiocytic lesions

BackgroundThe “C group” of the histiocytic disorders is characterized by non-Langerhans-cell histiocytic lesions in the skin, mucosal surfaces, or both, out of which Juvenile xanthogranuloma (JXG) is the most common typically affecting the skin. The eye is the most common extra-cutaneous site of JXG., we aim at providing our clinical and histopathological experience with this group of diseases including the adult-onset xanthogranuloma (AXG).MethodsThis is a retrospective cohort study of all patients with the tissue diagnosis of ocular and periocular cutaneous and mucocutaneous non-LCH disorders who presented to us over a period of 25 years (January 1993 to December 2018).ResultsTwenty patients were diagnosed as “Group C” disease with an age range of 2 months-60.9 years. Eleven patients were females (55%) and nine were males (45%). The involvement was mostly unilateral in 80.9%. All cases fell into the xanthogranuloma family with 11 JXG patients, 8 AXG patients of skin and ocular surface, and one patient with solitary reticulohistiocytoma (SRH). The clinical site of involvement in JXG was primarily in the eyelid in 5 patients (45%), ocular surface lesions in 2 (18%), iris in 2 (18%), choroidal and bilateral orbital lesions in 1 patient each (9%). The group of AXG, presented equally with eyelid lesions in 4/8 and ocular surface lesions in 4/8. The non-Langerhans’ histiocytic infiltrate showed supportive immunohistochemical staining properties (reactive to CD68 marker and negative to S-100 and langerin markers).ConclusionAmong the rare histiocytic disorders, xanthogranulomatosis is the commonest and has wide clinical manifestations. Accurate diagnosis needs to be supported by typical histopathological findings. JXG was the commonest in our study with relatively older mean age at presentation and frequent eyelid rather than iris involvement. AXG is often confused with xanthelasma when involving the eyelids with corneal limbal involvement is relatively frequent.

Plasma Exeresis for the Treatment of Benign Eyelid Lesions: A New Surgical Approach.

To report the plasma therapy technique and its clinical outcomes in patients with benign eyelid lesions. This is a retrospective, noncomparative, interventional study. The study included 71 eyes of 66 patients who underwent plasma exeresis for benign eyelid lesions in our clinic between February 2018 and December 2022. Patient symptoms, cosmetic outcomes, and complications were evaluated. The lesions were removed with a single plasma exeresis treatment in all patients. The mean size of the lesion at its largest part was 5.5 ± 1.2 mm (range, 3.0-8.8 mm). No complications were encountered during the procedure. The mean procedure time was 4.0 ± 0.7 minutes (range, 3-6 minutes). Postoperatively, only 3 cases (4.2%) with tarsal conjunctival extension had mild irritation symptoms such as pain, discomfort, and redness. The treated areas were fully improved cosmetically, and all patients were satisfied with the cosmetic outcomes. The plasma therapy technique for removing benign eyelid lesions offers minimally invasive surgery, less discomfort, fast recovery, and successful anatomical and cosmetic outcomes.

Eyelid Tumors at Razi and Farabi Hospitals, Tehran, Iran

Background: Eyelid tumors are common in the daily practice of skin tumors and are composed of benign and malignant lesions. Methods: This retrospective case series study collected histopathologic reports of eyelid tumors of patients treated between 2022 and 2023 in Razi and Farabi hospitals (Tehran, Iran). Patient data, including patient age, sex, location of the lesion, and recurrence, were collected. Descriptive and inferential statistics were used to characterize the subgroups. Results: The sample was composed of 154 eyelid tumor specimens, including 72 (47%) malignant cases, 80 (52%) benign cases, and 2 (1%) premalignant cases. Malignant tumors included 81.9% basal cell carcinomas (BCC), 15.3% basosquamous cell carcinomas (BSC), and 1.4% squamous cell carcinoma (SCC). The benign eyelid lesions were comprised of 20% intradermal melanocytic nevus, 11.3% epidermal cyst, 7.6% dermoid cyst, 10% seborrheic keratosis, 6.3% xanthelasma, 2.5% wart, 3.8% compound nevus, 5% fibroconnective tissue, 3.8% squamous papilloma, 3.8% neurofibroma, 2.5% comedone,2.5% apocrine hidrocystoma, 2.5% foreign body type granuloma, and 1.3% of others (arteriovenous hemangioma, cavernous hemangioma, cutaneous horn, etc.) The premalignant lesions were 2 cases of actinic keratosis. Benign lesions had an equal frequency of occurrence in the upper and lower lids. Malignant lesions were seen more in the lower lid. Premalignant lesions were seen in the lower lid. The mean age at diagnosis was 45.8 ± 23.06 years for patients with benign lesions and 63.5 ± 16.7 years for patients with malignant lesions. The mean age for patients with premalignant lesions was 81.5 ± 9.19 years (P &lt; 0.001). Conclusions: In our study, benign lesions were seen predominantly in young persons and malignant lesions were mostly seen in elderly persons. There is an equal occurrence of malignant lesions in males and females, and recurrence after excision was infrequent.

Peripheral Orbital Schwannoma : A Case Report

Introduction : The aim of this study was to report a rare case of a peripheral orbital nerve schwannoma. One of a thinkable diagnose and the goal of treatment.&#x0D; Case Illustration : A 17-years-old young lady with chief complaint was inferior eyelid lesion since 1 year and has gradually enlarged. Examination showed a space occupying lesion in the inferior right orbit around 10x5 mm that was firm to palpation, didn’t attach to the deep planes, painless, and did not displaced the eye. Computed tomography revealed a homogenous orbital mass, encapsulated, and did not invade adjacent structures&#x0D; Discussion : Lesion was treated with complete tumour resection via conjunctival / posterior site, and pathologic examination showed a schwannoma.Conclusion : Orbital schwannoma are infrequent tumours arising from the orbit coming behind inflammatory, vascular, and lymphoproliferative diseases. Treatment is complete resection of the lesion with subsequent monitoring to prevent recurrence.

Combined treatment of a giant palpebral keratoacanthoma

Aims/Purpose: To highlight the relevance of a therapeutic approach adapted to the clinical characteristics of the eyelid lesion found at the time of surgery to ensure an optimal functional and aesthetic result.Methods: Clinical case assessed, intervened and followed up at our centre.Results: A 76‐year‐old woman consulted for a nodular umbilicated lesion of recent appearance on the outer third of the upper eyelid of the left eye (UELE) measuring 0.5 cm in greatest diameter and 0.5 cm in elevation. The patient was placed on the waiting list for surgical excision and subsequent pathological examination (PE) of the lesion to confirm the initial clinical suspicion of keratoacanthoma (KA). One month later, the patient went to the operating room for surgery. During this time the lesion increased its initial size by more than 4 times, had a large necrotic centre, active borders and generated an evident left mechanical ptosis. As an alternative to the complete excisional surgery initially proposed, we offered the injection of neoadjuvant intralesional chemotherapy (CT) with the aim of reducing the size of the lesion to obtain a better functional and aesthetic result. The patient accepted this therapeutic alternative. KA was treated with weekly intralesional injections of 1 mL of methotrexate (MTX) 12.5 mg/mL. In our case, 3 injections were necessary to achieve a 78% reduction in the diameter of the lesion to allow reconstruction of the UELE with grafting of the contralateral upper eyelid. One week after the third injection of MTX, reconstruction of the UELE was performed after excisional surgery with wide margins for PE. One week later, the PE result ruled out malignancy and the graft had a pink appearance with complete vascular permeability, so the sutures were removed. Two weeks after reconstruction, the functional and aesthetic results were satisfactory.Conclusions: Therefore, in our experience, we recommend the above combined treatment for giant palpebral KA and stress the relevance of a therapeutic approach adapted to the clinical characteristics of the palpebral lesion at the time of surgery to ensure an optimal functional and aesthetic outcome.

Atypical Facial Chondroid Syringoma of Medial Canthus, A rare clinical entity

Abstract Introduction/Objective Chondroid syringoma (CS) is an uncommon, benign mixed tumor originating from the sweat gland. Its incidence rate is extremely low, estimated to be less than 0.01%. CS predominantly affects adult males and shows a preference for the head and neck region. Typically, the size of the lesion is smaller than 1.0 cm, and it presents as a solitary, painless, subcutaneous nodule that is soft to firm, non-ulcerative, and gradually progressive. Histologically, CS is characterized by a neoplasm composed of epithelial and myoepithelial cells, which are surrounded by a myxomatous, pseudochondromatous, or hyaline stroma containing mucous secretions. Although atypia is rare in CS, there is a potential for it to undergo malignant transformation. Methods/Case Report A 49-year-old man presented with a slowly growing mass on the medial canthus that had been present for 6 months. Examination revealed a tender, mobile nodule measuring 1.1 cm. An MRI of the head confirmed a subcutaneous lesion without involvement of deeper structures. Excisional biopsy of the lesion suggested adnexal carcinoma with involvement of the margins. The patient underwent Mohs surgery.Histopathology revealed localized basaloid epithelial proliferation forming solid sheets, trabecular, ductal structures with, chondroid myxoid stroma. Immunohistochemically, the tumor cells of solid sheets and trabeculae were positive for CK5/6, P63, and Vimentin, whereas the cells were focally positive for S100, Calponin, alpha Actin, and SOX10. Also, ductal epithelial cells were highlighted with CK7, Cam5.2, EMA, and CEA. Ki-67 showed 1–5% reactivity. A few satellite nodules with infiltrative margins were seen. The atypical features, including cell atypia and a focal infiltrating border, suggest atypical chondroid syringoma. This tumor is considered a low-grade lesion, and no unequivocal evidence of malignancy has been identified. Results (if a Case Study enter NA) NA Conclusion Awareness of chondroid syringoma as a rare cause of eyelid lesions is important because although it is a benign neoplasm, incomplete excision can lead to recurrence or malignant transformation. Chondroid syringoma rarely exhibits atypia but can convert to the malignant spectrum. When malignant, it has a significant potential for recurrence, metastasis, and even death. Due to the tumor's rarity, making an accurate preoperative diagnosis can be challenging. Therefore, the possibility of chondroid syringoma should be kept in mind when dealing with a gradually progressive, soft to firm subcutaneous swelling.

Use of chalazion clamp for excision of the eyelid margin lesion.

Reconstruction after eyelid lesion excision is very important. It calls for preserving normal eyelid function for the protection of the eye and restoring good cosmesis. It is important to precisely align the tarsal plate. However, the unique anatomy of eyelids often makes haemostasis difficult and surgical field obscured. We report an effective method to solve this problem. This retrospective study included 25 patients who underwent eyelid margin lesion excision using the chalazion clamp between March 2020 and October 2021. The chalazion clamp is placed on the desired location and tightened, providing a bloodless field for eyelid lesion removal. Without bleeding, visibility of the cut edges is improved considerably. It facilitates anatomical anastomosis of the tarsal plate. All 25 patients maintained normal eyelid function and good cosmesis, with no recurrence during the follow-up period. The use of the chalazion clamp during excision of the eyelid margin lesion could stabilize the eyelid, protect the eyeball from accidental injury and, and provide a clear bloodless operative field. It can ensure the neatness of the cut edges and offer better incision alignment for suture. It also avoids wasting too much time on haemostasis, without additional expensive equipment.

Unusual presentation of epidermal inclusion CYST: A case report

We report a case of a 8 year old girl who presented with painless progressive mass of the right upper lid that had been present after having a trauma at the age of 1 year with cricket ball and had slowly enlarged over period of 7 years. The mass had no signs of inflammation, tissue breach or central punctum. The mass was of cystic consistency with sharp well defined margin and freely movable not adherent to underlying structure measuring about 1-1.5cm in size. The mass was initially at centre of upper lid and had gradually moved to superotemporal region of upper lid that was completely excised and found to be a Epidermal Inclusion Cyst on histopathological examination. The presence of Epidermal Inclusion cyst at a site with no breach of tissue at the time of trauma and no punctum over the mass at the time of presentation is unusual, hence the purpose of our case report. Therefore it is important to consider Epidermal Inclusion Cyst in the differential diagnosis of eyelid lesions in children with atypical presentation.