Pictorial Case Study

THE CASE

A 48-year-old woman presented concerned about the appearance of lesions on both of her upper eyelids. These lesions had been present for at least 12 months but had enlarged and she now found them cosmetically unappealing.

Her vision was unaffected and she was otherwise well and on no medication.

On examination, there were two large, symmetrical, yellowish, raised lesions on each upper eyelid near the inner angles.

What is the diagnosis, management and differential diagnosis?

Diagnosis and management

The diagnosis is xanthelasma which present in the periorbital region as yellow or orange plaques. They are harmless, have no malignant potential and have no adverse effects. If they are very large they can lead to ptosis.

Fifty per cent of patients presenting with xanthelasma have normal lipid levels, although younger individuals have a higher incidence of hypercholesterolaemia.

Blood tests should be taken for lipid profile, and diabetes should be excluded because this can cause dyslipidaemia. In this woman's case, her lipid profile was normal.

She was referred to a plastic surgeon who surgically excised the xanthelasma.

However, they can also be treated by laser, electrodessication followed by curettage.

POSSIBLE DIFFERENTIAL DIAGNOSES

- Seborrhoeic keratoses.
- Naevi.
- Skin tags.

Differential diagnosis
- Seborrheic keratoses.
- Common in the elderly.
- Pigmented.
- Stuck-on appearance.
- Surgical excision.

Contributed by Dr Gwen Lewis, a GP in Windsor, Berkshire

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