This is an example of a lesion that grows rapidly, too rapidly for a neoplasm, over a period of a few weeks and then resolves spontaneously (Figure 15.4). It usually starts as a red papule, which grows quickly into a nodule with a keratin-filled crater. The lesion can resemble a basal cell carcinoma. Small lumps on the eyelids should be removed and biopsied. Larger lumps can be biopsied by taking a small segment from them before total excision if this proves necessary. Special care should be taken with the excision of any lesion on the eyelid in view of the risk of causing distortion of the lid margin or exposure keratitis.

Figure 15.4. Keratoacanthoma (with acknowledgement to Mr A. Sadiq).n

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