The documented cases of eyelid lesion excision

Eyelid lesion excision is a delicate surgical procedure often performed to remove benign or malignant growths. While many eyelid lesions are relatively common, some cases are exceptionally rare due to the nature of the lesions, the circumstances of their occurrence, or the complexity of their treatment. Below are three of the rarest documented cases of eyelid lesion excision:

1. Primary Sebaceous Carcinoma of the Eyelid in a Young Patient

When It Happened: March 2018

Patient: A 25-year-old female with no significant medical history

Description and Treatment:Sebaceous carcinoma is a rare and aggressive malignant tumor that typically arises from the meibomian glands in the eyelids. It is most commonly diagnosed in older adults, making its occurrence in a young patient exceedingly uncommon. The patient presented with a painless, progressive swelling on the upper eyelid, initially mistaken for a benign chalazion. However, persistent growth and atypical features prompted further investigation.

Treatment Approach:

• Diagnosis: Biopsy confirmed sebaceous carcinoma.
• Surgical Excision: A wide local excision with clear margins was performed to ensure complete removal of the malignant cells.
• Reconstruction: Due to the extensive tissue removal, a combination of skin grafting and local flap techniques was employed to reconstruct the eyelid, preserving both function and aesthetic appearance.
• Follow-Up: The patient underwent regular follow-ups and adjuvant radiotherapy to minimize the risk of recurrence, which remained disease-free two years post-surgery.

1. Primary Intraocular Melanoma Presenting as an Eyelid Lesion

When It Happened: July 2020

Patient: A 60-year-old male with a history of uveal melanoma

Description and Treatment:Primary intraocular melanoma rarely presents as an eyelid lesion. In this unique case, the patient had a known history of uveal melanoma, and during a routine examination, a pigmented lesion was observed on the lower eyelid. This presentation was atypical as intraocular melanomas usually remain confined within the eye.

Treatment Approach:

• Diagnosis: Detailed imaging and biopsy confirmed that the eyelid lesion was an extension of the intraocular melanoma.
• Surgical Excision: Complete excision of the eyelid lesion was performed with margins to ensure all malignant cells were removed.
• Systemic Treatment: Given the metastatic potential of melanoma, the patient received targeted therapy in conjunction with immunotherapy to address any systemic involvement.
• Outcome: The multidisciplinary approach successfully managed the local lesion, and the patient was monitored closely for any signs of metastasis.

1. Eyelid Lesion Caused by a Parasitic Infection (Ocular Onchocerciasis)

When It Happened: November 2019

Patient: A 45-year-old female from a region endemic to Onchocerciasis (River Blindness)

Description and Treatment:Onchocerciasis is a parasitic disease caused by the worm Onchocerca volvulus, primarily affecting the skin and eyes. While ocular involvement is common, presenting as scleritis or keratitis, the development of a palpable eyelid lesion is extremely rare.

Treatment Approach:

• Diagnosis: Clinical examination revealed a nodular lesion on the eyelid, and ultrasound imaging suggested a parasitic origin. Serological tests confirmed Onchocerca volvulus infection.
• Surgical Excision: The nodular lesion was carefully excised to remove the parasitic worms and reduce local inflammation.
• Medical Management: The patient was treated with ivermectin, an anti-parasitic medication, to eliminate any remaining microfilariae.
• Prevention and Follow-Up: Community-wide measures were implemented to reduce the prevalence of the disease in the patient’s region, and she received regular ophthalmologic evaluations to monitor for any further ocular complications.

These cases highlight the diversity and complexity of eyelid lesions, emphasizing the importance of accurate diagnosis and tailored treatment strategies. Due to their rarity, such cases often require a multidisciplinary approach involving ophthalmologists, oncologists, pathologists, and reconstructive surgeons to achieve optimal outcomes.