Lid reconstruction after tumour excision in a patient with seborrhoiec keratosis: A case report

Citation:
E NYENZE, J MUSTAPHA. "Lid reconstruction after tumour excision in a patient with seborrhoiec keratosis: A case report." JOECSA. 2016;20(1):40-44.

Abstract:

comABSTRACTSeborrhoiec Keratosis (SK) is one of the most common benign neoplasia of the eyelids, usually affecting elderly females. Typically, the lesions start as discrete, tan-dark brown, flat lesions starting on the face and progressing to other sun-exposed areas. The natural progression is generally an increase in size, thickness and pigmentation of these lesions. A variant of SK, Dermatosis Papulosa Nigra (DPN), has been described in black people, characterized by an earlier and more severe manifestation with multiple, profuse lesions. The diagnosis is clinical, although histopathological examination may be sought to confirm the diagnosis. These lesions are benign and usually only removed for cosmetic reasons. However, in some patients, concern or discomfort may warrant removal. Cryosurgery, electrodesiccation, curettage or shave excision are all effective methods of management. When eyelid lesions are excised, the resulting anterior lamellar defect can be repaired by primary closure, local skin flaps or Full-Thickness Skin Grafts (FTSG). We report a 60 year old female patient who presented with DPN and thick pigmented lesions on the eyelids of both eyes, causing mechanical ptosis, left lower lid ectropion and interfering with vision. She was successfully managed with excision and lid reconstruction for both eyes.Keywords: Seborrhoiec keratosis, Dermatosis papulosa nigra, Eyelid tumours, Eyelid reconstruction, Eyelid excisional biopsy, Glabellar flap INTRODUCTIONSeborrhoeic Keratosis (SK) is one of the most common benign neoplasia of the eyelids1. It usually affects elderly people, with a female preponderance and some cases of reported family history2. The exact cause is unknown and has been linked to sunlight exposure3. Typically, lesions are small, discrete and tan-brown flat macules, most frequently on the face and trunk4. With time, these lesions exhibit increase in size, thickness and level of pigmentation5. As they grow, the lesions become papules with the characteristic verrucous “stuck-on” appearance4. A variant of seborrhoiec keratosis, Dermatosis Papulosa Nigra (DPN) has been described in black people2. This variant manifests earlier, with multiple and profuse lesions which are larger, thicker and exhibit a more chronic and worsening course than classic SK. SK lesions are benign and do not usually require removal5. However, many patients present to dermatologists due to concern about possible skin malignancy when there is growth or increased pigmentation of the lesions6. Reasons for removal include cosmetic reasons, discomfort, itchiness or documented growth in the lesions. The diagnosis is clinical in majority of cases. However, especially if lesions are going to be removed, histopathological confirmation of the diagnosis may be sought. Histology of lesions is characterized by hyperkeratosis, papillomatosis, acanthosis with intraepithelial horn or pseudohorn cysts3. There are several options for

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