The eyelids can be affected by many different tumours. Two common tumours that often affects the eyelids of young patients are shown below with their clinical appearance.
 

Case 1

This young female complains of whitish lesions affecting her eyelids especially of the lower lids. The histology is as shown.

• What is the diagnosis?


Answer
Syringoma. These are benign tumour of the eccrine
sweat gland. They are usually bilateral and affect
teenagers and adult female.They measure about
1-3 mm in size. They may be associated with Down's syndrome.
a

• What does the histology show?
a
Answer
The histology is typical of syringoma containing cords 
and nests of solid cells with ducts within a a dense 
fibrous tissue stroma. The ducts are lined by a double
layer of compressed epithelial cells. On cross-section, 
some assume tadpole appearance and are characteristic
of this condition. The lumen of the ducts contain eosinophilic materials. See picture below for magnified view.

a
• What is the treatment of choice?

aa
Answer
Treatment is often unsatisfactory because of the extensive 
nature of the lesion. The patient should be reassured that they are not malignant. The lesion can be camouflaged with cosmetic. Large lesion can be excised.

This teenager presented with a nodular lesion below the left eye. The lesion is hard to palpation. The histology is shown on the left.

• What is the diagnosis?
a
Answer
Pilomatrixoma (also called the benign calcifying epithelioma 
of Malherbe). The tumour arises from the matrix cells at the 
base of a hair. It is usually solitary and affect young people.
a
a
• Is this a common site for this lesion?
a
Answer
Periorbital region is a common site for this lesion especially
the region of the eyebrow. See picture below.a

• What does the histology show?
a
Answer
The histology shows a mass surrounded by fibrous tissue 
within which are areas of calcification. The blue areas
surrounding the calcification represent viable basophilic cells.
On higher magnification, shadow or ghost cells can
be seen between the area of calcification and the basophilic cells. 
The shadow (ghost) cells represent areas of necrosis of 
previously viable basophilic cells, they have central clear areas 
due to loss of nucleoli. Calcification develops in the necrotic area with time.