Circumpunctal nevus.

Peripunctal naevi are very rare lesions of the eyelid and account for half of all the benign peripunctal tumors.1, 2 A female patient, aged 35 years, presented with left lower lid medial lesion since birth without associated epiphora. The lesion had not changed in size or color since the last 10 years. On examination, a pigmented and raised, dome shaped lesion was noted on the left lower lid at the junction of pars ciliaris and pars lacrimalis (Panel A). The lesion was circumferentially surrounding the punctum with the opening at the top of the dome (Panel A). Higher magnification showed a brownish black circumpunctal lesion with a fine ramifying vascularity on the surface (Panel B). The punctal opening was slit shaped with puffy punctal lips. The opening was patent and there was no resistance to passing the probe into the lacrimal sac. The lacrimal system was bilaterally patent. The surrounding eyelid skin, margins or conjunctiva were free of any pigment infiltration. Ocular examination was normal for both eyes. A diagnosis of left lower lid circumpunctal nevus was made and options of shave excision biopsy or observation were discussed (see Fig. 1).

Fig. 1

Circumpunctal Nevus: Panel A – Clinical external photo of the left lower lid showing a pigmented, raised domes shaped lesion in the region of punctum (Panel A). High magnification photograph of the nevus showing its circumferential location around the punctum with the opening on the top surface. Note the puffy lips of the slit shaped punctal opening and the fine vascularity on the surface of the lesion (Panel B).

Comment

Peripunctal naevi reported include junctional, compound and amelanotic variants.1, 2 They are predominantly subepithelial and have not been reported to cause compression effects on the punctum and canaliculus and hence are asymptomatic. Important differential diagnosis includes pigmented cysts, pigmented squamous papillomas, melanomas and basal cell carcinoma.1, 2

Financial disclosure

Mohammad Javed Ali received support from the Alexander von Humboldt Foundation for his research and he also receives royalties from Springer for the textbook “Principles and Practice of Lacrimal Surgery’. Friedrich Paulsen was supported by Deutsche Forschungsgemeinschaft (DFG) grants PA738/1-1 to 1-5 as well as PA738/2-1. He receives royalties from Elsevier for the anatomy atlas “Sobotta”.