• Description: A benign melanocytic lesion on the eyelid; can be pigmented or non-pigmented, and may show changes over time.

• Treatment: Observation; excision if suspicious for malignancy or for cosmetic reasons.

• Emergency?: No, but biopsy may be needed if there are signs of malignancy.

• Helpful Testing: Referral for biopsy if atypical. 

• Differential Diagnoses: Sebaceous cell carcinoma, basal cell carcinoma, melanoma.

• Description: A congenital condition characterized by hyperpigmentation of the eyelid and conjunctiva, usually in individuals of Asian descent; associated with an increased risk of melanoma.

• Treatment: Observation; biopsy or surgical excision if malignancy is suspected.

• Emergency?: No, but regular monitoring is important for malignant transformation.

• Helpful Testing: Referral for biopsy if suspicious of malignancy. 

• Differential Diagnoses: Basal cell carcinoma, sebaceous cell carcinoma, conjunctival melanoma.

• Description: A benign, slow-growing tumor of the skin that appears as a waxy, raised, often pigmented lesion; can occur on the eyelids or periocular skin.

• Treatment: No treatment required unless the lesion becomes irritated or unsightly; cryotherapy or excision if needed.

• Emergency?: No, unless there is concern for irritation or malignant transformation.

• Helpful Testing: Referral for biopsy if suspicious for malignancy. 

• Differential Diagnoses: Basal cell carcinoma, squamous cell carcinoma, actinic keratosis.

• Description: A benign, wart-like lesion typically found on the eyelids or conjunctiva, caused by human papillomavirus (HPV).

• Treatment: Excision for cosmetic reasons or if irritation occurs.

• Emergency?: No, but should be monitored for recurrence.

• Helpful Testing: None. 

• Differential Diagnoses: Seborrheic keratosis, basal cell carcinoma, actinic keratosis.  

Notes:

Grows slowly and in groups. Viral papillomas are found in groups and are more common in children, but older adults usually develop individual or widely spaced papillomas that are not thought to be viral in origin.

• Description: A common, benign viral infection caused by HPV, appearing as raised, rough lesions; can affect the eyelids or periocular skin.

• Treatment: Excision, cryotherapy, or topical treatments (e.g., salicylic acid). Often resolves spontaneously.

• Emergency?: No, but should be managed to avoid irritation or spread.

• Helpful Testing: None. 

• Differential Diagnoses: Squamous papilloma, seborrheic keratosis, basal cell carcinoma.'

Notes:

Usually asymptomatic and appears as a pedunculated or sessile hyperemia mass on eyelid or tarsal conjunctiva with minimal surrounding inflammation.