Squamous Papilloma : Most common benign lesion of the eyelid. The lesion can be either sessile or pedunculated.

Hyperkeratosis papilloma of the eyelid. An anatomic clinical case. J Fr Ophtalmol.  2001 May;24(5):558-61

 A clinicopathologic case of an 80-year-old male patient with a single cutaneous tumor on the upper part of the left eyelid is reported. It was a grayish and pigmented mass covered with a thick keratin layer, well circumscribed, and exophytic. After surgical removal, histopathology showed that the tumor had a papillomatous pattern and was growing under a thick layer of hyperkeratosis. It was a typical squamous cell papilloma. This tumor belongs to the benign eyelid tumor group and can be found on the eyelids of elderly people.

Seborrheic keratosis The lesions occur in middle aged   and elderly patients. These are usually tan to black, pigmented, well demarcated lesions with a friable surface.

Palpebral seborrheic keratosis: a case study. J Fr Ophtalmol. 2004 Dec;27(10):1146-9

INTRODUCTION:  Seborrheic keratosis is the most frequent palpebral tumor, observed for the most part in the second half of life. It may be confused clinically with a basal cell carcinoma or a melanoma. The histopathological study confirms the diagnosis. OBSERVATION: A 69-year-old man presented with a giant superior palpebral tumor leading to ptosis of the eyelid, which had evolved over 5 years. Examination found a pigmented cerebriform multilobed granulated mass, with a smooth surface and a more or less seborrheic aspect, pedicled in places, covering the entire eyelid but sparing the internal angle. This aspect suggested melanoma, basal cell carcinoma or seborrheic keratosis. Histological biopsy revealed basal cell carcinoma. Excision with palpebral reconstitution using palpebral flaps was performed. The histopathological analysis of the tumor concluded in seborrheic keratosis. DISCUSSION: Seborrheic keratosis is a frequent tumor of the face and eyelids. Its highly pigmented clinical aspect can be confounded with a nevus or a melanoma, whereas the histological aspect can suggest basal cell carcinoma or squamous cell carcinoma, but the basal membrane is always intact. Several treatments have been proposed, including electrocoagulation, cryotherapy, dermabrasion, as well as CO2 laser treatment. However, when there is doubt with regard to the histological nature, surgery is preferred. CONCLUSION: This was a case of seborrheic keratosis, atypical in that it covered the entire upper eyelid and produced a highly disfiguring aspect and functional problems, requiring surgical treatment with eyelid reconstruction.

Seborrheic keratosis of the eyelid in a young woman.J Fr Ophtalmol. 2002 Jan;25(1):104-7

Keratoacanthoma Appear as a dome-shaped nodule with a central keratin-filled crater and elevated rolled margin.

Periocular keratoacanthoma: clinical features, pathology, and management.Ophthalmology. 2003 Jul;110(7):1403-7.

PURPOSE: To review the clinical features and results of surgical treatment of keratoacanthoma of the eyelids. DESIGN: Retrospective, interventional case series. PARTICIPANTS: Ten patients. METHODS: Chart review of all eyelid keratoacanthomas treated between 1992 and 2001. MAIN OUTCOME MEASURES: Adequate excision, recurrence rate, and complications. RESULTS: Patient ages ranged from 27 to 78 years, with a mean age of 59 years. Six patients were male and four were female. The lesion was found on the lower lid in five patients, upper lid in two, medial canthus in two, and lateral canthus in one. The maximum diameter of the lesion varied from 2 to 25 mm, with a mean of 7.2 mm. All lesions were treated by surgical excision, with frozen-section control of margins in five cases. All lesions were excised completely with clear resection margins, and there were no cases of recurrence. The only complication was a minor wound infection in one patient. Mean follow-up was 34.5 months. CONCLUSIONS: Because of the aggressive nature and uncertain relationship to squamous cell carcinoma, we recommend excision of periocular keratoacanthoma. Surgical excision of eyelid keratoacanthoma provides good results and a very low risk of recurrence. Frozen-section control of margins should be used in selected cases to ensure complete excision.

Giant keratoacanthoma of the eyelid.J Fr Ophtalmol. 2005 Dec;28(10):1115-9.

The clinicopathologic case of a 76-year-old male with a giant tumor of the left eyelid is reported. Histopathological diagnosis was a keratoacanthoma. The lesion was treated with an injection of 5-Fluoro-Uracil and oral treatment with acitretin (Soriatane), causing the lesion to disappear quickly. Clinical and histopathological characteristics of keratoacanthoma are important to know because the differential diagnosis is epidermoid carcinoma. This treatment is original in that the surgical exeresis usually done in this kind of tumor would have been too mutilating for the eyelid in such a case.

Actinic keratosis This is a common precancerous lesion of the eyelid. It results from prolonged exposure to sunlight with inadequate protection.

Bowen's disease Presents as erythematous, pigmented, crusty, scaly, keratotic plaques.

Bowen disease of the eyelid successfully treated with imiquimod.
Ophthal Plast Reconstr Surg. 2005 Jul;21(4):321-2.

We present a case of Bowen disease affecting the eyelid that was successfully treated with imiquimod. The clinical presentation, histopathology, and treatment of this case are presented. The tumor was treated with imiquimod for 3 months, leading to complete resolution of the disease both clinically and histopathologically. There was no evidence of recurrence 5 months after treatment cessation. Imiquimod was safely used on the eyelid in this case and may avoid extensive periocular tumor excision and reconstruction in Bowen disease.

Squamous Cell Carcinoma Not a common tumour of the eyelid (2-6% of malignant tumour at this site). Usually occurs in elderly patients. It usually invoves the margin of the lower eyelid. The precursor lesions include actinic keratosis, Bowen's disease and xeroderma pigmentosum.

Squamous cell carcinoma of the eyelid. Ophthal Plast Reconstr Surg.1994 Sep;10(3):153-9

A total of 24 patients (12 men and 12 women) with squamous cell carcinoma of the eyelid were identified from pathology records at Wills Eye Hospital from 1978 through 1987. Squamous cell carcinoma accounted for 24 of 648 (3.7%) malignant eyelid lesions submitted during the 10-year study period. The median age of patients at the time of diagnosis was 72 years (range, 55 to 96 years). Initial therapy of all tumors involved surgical excision. Four patients developed clinical recurrence of squamous cell carcinoma in a median of 7.5 months after surgery. There were no tumor recurrences when frozen section techniques were applied during the initial surgical excision. The data suggest that the risk of persistence or recurrence of tumor was increased for patients who delayed seeking medical care after the lesion was first noticed and when frozen section control was not used during surgery. None of the patients were known to have developed metastases, and there were no tumor-related deaths.

Well-differentiated squamous cell carcinoma of the eyelid arising during a 20-year period.  Arch Opthalmol.2000 Mar;118(3):422-4

An 81-year-old man had a keratotic eyelid lesions for 20 years. He eventually sought treatment by ophthalmic plastic surgery. Clinically, the lesion resembled a keratoacanthoma. Findings from histologic examination of the excision biopsy specimen showed a squamous cell carcinoma. The lesion was completely excised. This case demonstrates the difficulty in making a correct clinical diagnosis of a keratotic eyelid lesion. Performing a histologic examination of nonregressed keratotic lesions is essential to exclude a squamous cell carcinoma.

Squamous cell carcinoma of the lower lid in a 19-month-old girl with xeroderma pigmentosum.Eur Arch Otorhinolaryngol. 2000;257(2):77-9

Basal Cell Carcinoma Most common malignant tumour of the eyelid. It usually involves the lower eyelid and inner canthus in elderly patients.

Histological characteristics of basal cell carcinoma of the eyelid.
Ophthalmic Res. 2007;39(1):45-8. Epub 2006 Dec 11.

PURPOSE: To evaluate the histological subtypes of basal cell carcinoma (BCC) of the eyelid and to determine their effect on the size, depth of invasion and need of retreatment of a nonselected patient material seen in south-western Finland. METHODS: We studied the case records and the histological characteristics of BCC of the eyelid treated at the Turku University Eye Clinic during the years 1988 through 1997. The material consisted 103 patients (103 BCC tumors of the eyelid). All tumors were surgically excised. Histological slides were reviewed by a pathologist and the material was divided into histopathological subtypes. RESULTS: In 78.3% of the cases, the diameter of the lesion was smaller than 10 mm. The most frequent histological subtype was nodular (84.5%) followed by sclerosing (5.8%), micronodular (4.9%), keratotic (2.9%) and superficial (1.9%) types of BCC of the eyelid. Only patients of the nodular subtype showed recurrences (11 cases). The size of the tumor and the depth of invasion correlated directly with each other. However, some nodular types of BCC tumors smaller than 10 mm in diameter extended to a depth of more than 4.0 mm. CONCLUSIONS: The nodular subtype of BCC should be regarded as a potentially invasive and recurrent tumor. Histopathological examination and subtyping of all BCC tumors is recommended.

Merkel cell (neuroendocrine) carcinoma Merkel cell carcinoma is a cutaneous neuroendocrine malignant tumor arising from Merkel cells. These cells are common along the eyelid margin in between the eyelashes.  Immunohistochemical and ultrastructural studies may be necessary for an histopathological diagnosis.

Merkel cell carcinoma of the eyelid and periocular tissues. Am J Ophthalmol. 1992 Jun 15;113(6):674-80.

Five patients had eyelid and periocular Merkel cell carcinoma. The tumor was located on the left lower eyelid in two patients, the left upper eyelid in one patient, the right upper eyelid in one patient, and was metastatic to the right outer canthus in one patient. The mean duration of symptoms was approximately four months. The diagnosis of Merkel cell carcinoma was not suspected clinically in any of the four primary eyelid cases, but was only established on histopathologic examination of biopsy specimens. Light microscopy disclosed carcinoma with small primitive cells in all five tumor biopsy specimens. Immunohistochemical studies showed neuron-specific enolase and keratin and transmission electron microscopy demonstrated neurosecretory granules typical for Merkel cell carcinoma. All five patients in this study were treated with wide surgical excision of the eyelid tumors with intraoperative frozen-section monitoring of the margins of resection. The left lower eyelid Merkel cell carcinoma spread to the preauricular lymph node in one patient. This patient subsequently died of metastatic Merkel cell carcinoma. One patient with metastatic right outer canthus Merkel cell carcinoma received radiotherapy (6,550 cGy). Eyelid Merkel cell carcinoma has the potential for recurrence and metastatic spread. We recommend lifetime follow-up for patients treated for eyelid Merkel cell carcinoma.