A 57 year old woman presents for removal of a growth on her right eyelid. The lesion was first noted several months ago and has been slowly increasing in size. She denies bleeding or discomfort. Examination reveals a 0.5cm hyperpigmented papule with a slightly crusted center. No similar lesions are noted elsewhere.
Submit your diagnosis to see full explanation.
Most tumors of the eyelid are epidermal neoplasms; these are benign but often cosmetically undesirable.1 Inverted follicular keratosis (IFK) is an uncommonly encountered, slowly growing tumor that often arises in association with hair follicles. The growths are most often found on the face of middle-aged men, although a recent analysis of periocular IFKs found that the majority of patients are women.2,3 IFKs are usually under 1.0cm in diameter and present as a hyperpigmented to pink papule. Multiple lesions may be a marker for Cowden syndrome.4
The cause of IFKs is unknown; some postulate that they represent variants of either verruca vulgaris or seborrheic keratoses.5 Definitive diagnosis is made on histopathologic evaluation, and surgical excision is curative.
Stephen Schleicher, MD, is director of the DermDox Center for Dermatology, as well as an associate professor of medicine at Commonwealth Medical College and a clinical instructor of dermatology at Arcadia University and Kings College
1. Yu SS, Zhao Y, Zhao H, Lin JY, Tang X. A retrospective study of 2228 cases with eyelid tumors. Int J Ophthalmol. 2018;11(11):1835–1841.
2. Bolognia JL, Jorizzo JL, Rapini RP. Benign epidermal tumors and proliferations. Dermatology. 2nd ed. London:Mosby Elsevier;2008:1666. p. 1666.
3. Díez-Montero C, González González D, Pérez Martínez E, Schellini S, Galindo-Ferreiro A. Periocular inverted follicular keratosis: a retrospective series over 17 years. Jpn J Ophthalmol. 2019;63(2):210-214.
4. Larumbe A, Iglesias EM, IIIarramendi JJ, Córdoba A, Gállego M. Acral keratoses and inverted follicular keratosis presenting Cowden disease. Actas Dermosifiliogr. 2007;98(6):425–429.
5. Hocker S, Rabinovitz HS. Oliviero M, Grant-Kels J, Scope A. Reflectance confocal microscopy of an inverted follicular keratosis mimicking a squamous cell carcinoma. Dermatol Pract Concept. 2017;7(4):39-42.