Molluscum contagiosum may present on the eyelids with characteristic lesions and secondary follicular conjunctivitis (see Chapter 21).

Table 17-2

Neoplasms and Other Noninfectious Eyelid Lesions

Malignant tumors arising from eyelid skin or conjunctiva (eg, basal cell carcinoma, squamous cell carcinoma, melanoma) are relatively common in adults, but they are extremely rare in children. These tumors are discussed elsewhere in the BCSC (see Section 4, Ophthalmic Pathology and Intraocular Tumors; Section 7, Orbit, Eyelids, and Lacrimal System; and Section 8, External Disease and Cornea). Pediatric cases are likely to be associated with underlying systemic disorders that predispose the patient to malignancy, such as basal cell nevus syndrome or xeroderma pigmentosum. In rare cases, rhabdomyosarcoma may present as an eyelid or conjunctival mass.

Benign lesions of the ocular surface and surrounding skin are common, and these may be classified as originating from epithelium, melanocytes, or vascular tissue.

Capillary Malformations

Port-wine stain (PWS; also referred to as port-wine nevus, nevus flammeus) is a congenital vascular malformation that manifests as a flat red or pink cutaneous lesion. It may lighten during the first year of life but then tends to become darker, thicker, and more nodular over time. PWS is associated with Sturge-Weber syndrome and Klippel-Trénaunay-Weber syndrome (see Chapter 28) and is seen in combination with ocular melanosis in phakomatosis pigmentovascularis. Glaucoma can occur in affected eyes and can be difficult to treat (see Chapter 22). Lasers can be used to decrease the skin pigmentation.

Congenital Nevocellular Nevi of the Skin

Congenital nevocellular nevi can occur on the eyelids; they may cause visual deprivation amblyopia or undergo malignant transformation (Fig 17-9). The risk of malignant transformation increases with the size of the lesion; large lesions (>20 cm) have a 5%–20% risk of malignant transformation. Observation is often recommended for small (<1.5 cm) and medium-sized (1.5–20.0 cm) lesions.