Clinical features and management of eyelid margin nevi

Orbit. 2024 Feb;43(1):8-15. doi: 10.1080/01676830.2023.2169717. Epub 2023 Jan 23.


Purpose: Acquired melanocytic nevi are common eyelid lesions; however, their clinical presentation is not well documented.

Methods: In this retrospective study, clinical records were reviewed in patients evaluated between 2005 and 2022.

Results: Eyelid margin nevi (n = 150) were more commonly excised in female (78%) and Caucasian (86%) patients. Change in appearance/size were frequent presenting complaints, and 17% experienced ocular symptoms. Referring diagnosis included other benign lesions (11.3%), and concern for malignancy (16.7%). Many individuals (38.7%) noted their lesion for ≤5 years. Nevi were distributed across the 4 margins (9% peripunctal), and 88% had a regular base. Visible pigmentation was more common in non-Caucasians (95.2%) than Caucasians (41.1%). Lashes grew through 60.7% of nevi and were often misdirected.Nevi were treated with superficial excision and cauterization. Histologic subtypes included: dermal (86.6%), compound (9.4%), blue (2.7%), junctional (0.7%), lentiginous dysplastic (0.7%). An irregular base (p=0.042) and pigmentation (p=0.056) were more common in compound than dermal nevi. Lash line quality and appearance were improved in the majority of patients returning for follow-up, although postoperative trichiasis, marginal erythema, and residual pigmentation were observed.

Conclusions: Melanocytic nevi commonly involve the eyelid margins and have a variety of presentations and appearances. Existing nevi can change, and new lesions appear throughout adulthood. Stable, benign appearing nevi can be observed. Shave excision provides a diagnosis and improved appearance for symptomatic or suspicious lesions, with few serious complications. Malignant transformation is rare, although evidence for recurrence warrants further evaluation.

Keywords: Eyelid nevus; blue nevus; eyelid lesion; peripunctal nevus.

MeSH terms

  • Adult
  • Eyelid Neoplasms* / pathology
  • Eyelid Neoplasms* / surgery
  • Eyelids / pathology
  • Eyelids / surgery
  • Female
  • Humans
  • Nevus* / pathology
  • Nevus* / surgery
  • Nevus, Pigmented* / pathology
  • Nevus, Pigmented* / surgery
  • Retrospective Studies
  • Skin Neoplasms* / pathology
  • Skin Neoplasms* / surgery