Vikram Durairaj, MD discusses highlights from his lecture Orbital and Periorbital Lesions: Seeing What's There at the 2022 PA/NP Elevate-Derm Conference in Tucson, Arizona

In this video

In conversation with PA Douglas Deere-Jarrell, Dr. Durairaj describes the range of eyelid and adnexal lesions referred to an oculoplastic surgeon. Most, fortunately, turn out to be benign — though he notes they "often require biopsy to confirm that they're benign" — while malignant lesions, ideally caught before they reach an advanced stage, warrant closer management.

He walks through the history and exam findings that raise concern for malignancy, and touches on how presentations differ across skin tones, with fewer skin cancers but more benign lesions such as apocrine hidrocystomas seen in patients with darker skin.

  • A history of prior skin cancer, sun exposure, or radiation exposure raises suspicion for a malignant eyelid lesion.
  • On exam, watch for disruption of eyelid architecture, loss of lashes (madarosis), ulceration, irregular borders, and hyperkeratosis — all reasons to consider a biopsy.
  • The majority of referred eyelid lesions are benign, but biopsy is frequently needed to confirm it.
  • Darker skin tones show fewer basal cell, squamous cell, and melanoma lesions, but more benign lesions such as apocrine hidrocystomas.