Pleomorphic adenoma with extensive myoepithelial component (myoepithelioma) of the lower eyelid

A 58-year-old woman presented with a nodular lesion on the medial part of her left lower eyelid. The lesion had been removed 10 years ago, but showed subsequent recurrence with slow growth. The lesion was again partially removed at another institution prior to presentation. Afterward removal, the persistent lesion had rapid growth. On presentation to us, the lesion showed a clinical appearance that was very similar to a nodular basal cell carcinoma. A pentagonal full-thickness resection biopsy was performed. The pathologic study revealed clusters of tumor cells and some ductal proliferations. Immunohistochemistry demonstrated positive staining for p63, S-100, and smooth muscle actin. No atypia was observed. A diagnosis of pleomorphic adenoma with extensive myoepithelial component (myoepithelioma) was made. The authors conclude that myoepithelioma should be considered in the differential diagnosis of nodular recurrent masses in the eyelids of adults. Definitive diagnosis is possible only after surgical biopsy.