Bilateral extensive nodular xanthelasma palpebrarum: an infrequent case report.

PURPOSE: To report a rare case of extensive bilateral xanthelasma palpebrarum (XP). A 70-year-old man presented with nodular lesions of his eyelids for 12 years. The skin changes began with his left lower eyelid and progressively spread to both lateral-inferior and infero-medial periorbital areas. The lesions were yellow nodules that were hard, extensive, multiple and coalescent.

METHOD: The tumors of this patient's eyelids underwent resection and tissue was processed for light microscopic examination.

RESULT: Under light microscopy, many foamy xanthoma cells were found in the dermis, often nested around capillaries. Touton giant cell were also be observed, and tissue fibrous hyperplasia was obvious. The pathological changes were seen in the orbicularis oculi muscle, where many foamy xanthoma cells were seen between the muscle fibers.

CONCLUSION: XP is the most common cutaneous xanthoma and typically presents in the middle-aged and elderly. This presentation of XP is notable because of its extent. The light microscopic appearance confirmed the diagnosis of XP. Surgical intervention provided substantial cosmesis.