Eyelid Papilloma

Eyelid papilloma is a benign epithelial proliferation. Two common forms:

• Squamous papilloma (skin tag, acrochordon): soft, pedunculated, flesh coloured, common in older adults.
• Viral papilloma (verruca vulgaris): caused by human papillomavirus types 6 and 11 (and 2, 4), occurs in children and young adults, sometimes with auto inoculation to the conjunctiva.
• Related lesions: seborrhoeic keratosis (waxy, stuck on, brown), cutaneous horn, and molluscum contagiosum (umbilicated, pearly papules from a poxvirus).

• Slowly growing, painless papule or filiform lesion, usually on the lid margin or skin.
• Squamous papillomas: pedunculated and soft. Verruca: rough, keratotic, with finger like projections.
• Viral lesions can seed the conjunctiva and cause papillary conjunctivitis or keratitis.
• Molluscum: multiple umbilicated nodules; can cause follicular conjunctivitis and punctate keratitis when on the margin.
• Rapid growth, ulceration, madarosis, bleeding or irregular pigment are red flags for malignancy.

• Clinical diagnosis. Dermoscopy may help.
• Excisional biopsy and histology for atypical, changing, pigmented or ulcerated lesions, particularly where the lash line is lost.
• Examine the eye, including the everted lid, for associated conjunctival lesions.

• Observation for small, asymptomatic lesions; many viral lesions regress within 6 to 24 months in children.
• Shave or snip excision at the base with light cautery for pedunculated lesions under local anaesthetic (lidocaine 1 percent with adrenaline).
• Cryotherapy (liquid nitrogen, two freeze thaw cycles of 5 to 10 seconds) for verruca away from the lid margin, taking care to protect the globe.
• Molluscum: curettage, cryotherapy, or expression of the core with a sharp instrument, topical imiquimod 5 percent three times weekly for 6 to 12 weeks in selected cases.
• Conjunctival involvement: surgical excision with cryotherapy at the base; topical interferon alpha-2b 1 million IU/mL four times daily or mitomycin C 0.02 percent for recurrent disease.
• Avoid pulsed lasers near the globe. Send all excised tissue for histology.
• Counsel on recurrence and contagion in viral forms; avoid sharing towels.