The Spectrum of Eyelid Lesions: Histopathologic Classification of Benign, Malignant, and Non-Neoplastic Findings

Background: Extensive literature exists on characterizing and differentiating eyelid neoplasms that may mimic benign lesions. However, there is limited epidemiologic data on the most common benign and malignant neoplasms of the eyelid, especially within the United States. Methods: A retrospective cohort study was performed of all histopathologically-confirmed eyelid biopsy specimens between 1/2000 - 12/2021 at a large tertiary care academic medical center. Age, sex, lesion site and laterality, and diagnosis was collected. Specimens were stratified into benign and malignant eyelid lesions. Results: 561 eyelid cases (male = 270, female = 291) were analyzed, 460 benign (82.0%) and 101 malignant (18.0%). Mean age for benign lesions was 60.6 ± 15.2 years. Mean age for malignant lesions was 67.6 ± 12.5 years. Most common benign lesions were papillomas (n=146: 31.7%), hidrocystoma (n=65: 14.1%), and epidermal inclusion cyst (n=41: 8.9%). Most common malignant lesions were basal cell carcinoma (n=72: 71.3%), squamous cell carcinoma (n=17: 16.8%), and melanoma (n=5: 5.0%). Conclusions: The number of benign eyelid lesions outweighs those of malignant lesions. Benign lesions were commonly seen at an earlier age compared to malignant lesions. Epidemiologic data presented adds to knowledge about lesions and can help inform clinical differential diagnoses.