Keratoacanthoma of the eyelid. Problems and pitfalls of diagnosis and therapy

Background Keratoacanthoma of the eyelid is a benign skin lesion. Because it regresses spontaneously observation without surgical intervention is the generally accepted method of management. This concept, which was developed in the six ties, is questioned on the basis of personal experience and a review of the literature. Recommendations for a rational management of the disease are suggested. Method Two patients with clinically diagnosed eyelid keratoacanthomas are reported with their complicated disease course. A review of the dermatological and ophthalmic literature is presented. Conclusions For the correct diagnosis a sufficiently large and representative histological specimen is mandatory. The difficulty of differentiating between keratoacanthoma and squamous cell carcinoma is stressed. Surgery of advanced eyelid lesions is so much more destructive that early simple excision is advocated rather than a policy of initial observation .