INTRODUCTION A papilloma is any lesion that is papillomatous in growth pattern: that is a smooth, rounded, or pedunculated elevation. The squamous papilloma is a generic term for any papilloma of nonviral origin. Also known as a fibroepithelial polyp, acrochordon, or skin tag, this neoplasm commonly occurs on the eyelid, neck, axilla, and groin. This is a benign tumor of squamous epithelial origin, and this is the most common benign lesion found on the eyelid, representing 15% to 30% of all benign lesions on the lids. It can be seen at any age but occurs most frequently in patients over the age of 30 years.
CLINICAL PRESENTATION Papillomas on the eyelid present as small 2 to 3 mm flesh-colored sessile or pedunculated masses. They may be single or multiple. Occasionally they can develop on the palpebral or bulbar conjunctiva. They typically have thickened hyperkeratotic epithelium and may show multiple finger-like projections. On close examination it may be possible to identify a central vascular core.
HISTOPATHOLOGY Papillomas (acrochordons; skin tags) are highly variable histologically. Furrowed papules are most common on the eyelids and are characterized histologically by epidermal hyperplasia with a seborrheic keratosis-like appearance, as illustrated here. The hyperplastic epidermis forms interdigitating cords. Horn cysts may be present, though they are not common.
DIFFERENTIAL DIAGNOSIS The differential diagnosis includes seborrheic keratosis, actinic keratosis, verruca vulgaris, intradermal nevus, keratoacanthoma, and sebaceous carcinoma. Occasionally malignant lesions can look like a papilloma, but these more often have telangiectatic vessels or are associated with lash loss or ulceration.
TREATMENT Treatment may be indicated for large lesions that interfere with vision or cause ocular irritation, or for lesions of cosmetic concern. Removal is by simple surgical excision or light electrodessication. If the base is broad, a shave biopsy may be appropriate in order to preserve the lid margin and lash line, even though recurrence may be expected over several years.
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