Cutaneous lupus erythematosus of the eyelid as a mimic of squamous epithelial malignancies: a clinicopathologic study of 9 cases.
OBJECTIVE
To describe 9 cases of chronic cutaneous lupus of the eyelid, its potential similarities with squamous epithelial malignancies, and clinical and histopathologic features that assist in distinguishing lupus from epidermal neoplasia.


METHODS
The authors identified and reviewed 9 cases of cutaneous lupus involving the eyelid at their institutions since 1991. Published cases of cutaneous lupus involving the eyelid were identified using Ovid MEDLINE and PubMed and references within the articles.


RESULTS
The average patient age at presentation was 52 years old (range 33-89) with a female-to-male ratio of 8:1. The right lower eyelid was the most commonly affected location, with 44% of the cases occurring at this site. Lesions had been present on average for 2.5 years prior to presentation (range 2-60 months). Lesions were clinically heterogeneous, ranging from macules to crusted shallow ulcers. In 44% of cases, the preoperative clinical diagnosis was that of either squamous cell carcinoma or basal cell carcinoma. The patients thought to have a skin malignancy were 10 years older at presentation, more likely to be male, and more likely to have ulcerative lesions with rapid onset when compared with the other lupus patients.


CONCLUSIONS
A subset of patients with lupus (particularly discoid lupus) involving the eyelid have clinical features mimicking patients with squamous epithelial malignancy. In cases such as these, biopsies are critical for establishing the diagnosis and pursuing appropriate therapeutic approaches.
Department of Pathology, Duke University Medical Center, Durham, North Carolina 27710, U.S.A. Papal002@mc.duke.edu
John A
JA
Papalas
Michael G
MG
Hitchcock
Parag
P
Gandhi
Alan D
AD
Proia
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D002280:Basal Cell Carcinoma / Q000473:pathology*; D002294:Carcinoma, Squamous Cell / Q000473:pathology*; D017679:Cryotherapy; D003937:Diagnosis, Differential; D005141:Eyelid Diseases / Q000175:diagnosis* / Q000628:therapy; D005142:Eyelid Neoplasms / Q000473:pathology*; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D053685:Laser Therapy; D008179:Lupus Erythematosus, Discoid / Q000175:diagnosis* / Q000628:therapy; D008297:Male; D008875:Middle Aged
D005938:Glucocorticoids