Vikram Durairaj, MD, discusses highlights from his lecture, Danger Zones Around the Eye: How, When, and If We Should Biopsy Around the Eye, on Friday, November 4, 2022, at the PA/NP Elevate-Derm Conference in Tucson, Arizona.
In this video
In conversation with Douglas Jarrow, PA, Dr. Durairaj makes the case for slowing down on the periorbital exam. As the "frontline" of skin examination, dermatologists, PAs, NPs, and primary care physicians should be examining the eyelids carefully — around one in five cutaneous malignancies in the head and neck show up around the eyelid or periorbital region. He points to clinical warning signs that should prompt a biopsy: loss of lashes (madarosis), ulceration, eyelid malposition (an ectropion or entropion), and a patient reporting a non-healing or enlarging lesion.
He also draws a practical line between the danger zones and the safe zones. Lesions involving the eyelid margin, close to the lacrimal system, or at the medial or lateral canthi are trickier and warrant referral, while lesions away from those structures are very reasonable to biopsy safely — especially for clinicians who haven't been specifically trained in eyelid biopsies.
- Roughly one in five head and neck cutaneous malignancies present around the eyelid or periorbital region, so the eyelid exam deserves careful, thoughtful attention.
- Watch for suspicious signs: loss of lashes (madarosis), ulceration, eyelid malposition (ectropion or entropion), and a non-healing or enlarging lesion.
- Danger zones warranting referral include the eyelid margin, the lacrimal system, and the medial or lateral canthi.
- Lesions that don't involve the eyelid margin, lacrimal system, or canthi are safe areas that are reasonable to biopsy.
- Comfort with eyelid biopsies depends on training — refer the tricky zones if you haven't worked with the right person to build that skill.
