Ophthalmologic oncology: alopecia of the eyelashes

The variety of lesions that can cause alopecia of the eyelashes (Table 1) demonstrates the need for accurate diagnosis. A full-thickness biopsy of lid margin with appropriate three-suture closure can leave an imperceptible defect and may provide invaluable information. Although a partial-thickness lid biopsy is certainly appropriate for many common eyelid tumors such as basal-cell carcinomas or nevi, we feel strongly that a full-thickness lid biopsy is indicated when discussing chronic eyelid lesions that cause alopecia. The information gathered from a full-thickness biopsy is far superior especially in those lesions which cause chronic blepharitis or especially in a case of a recurrent chalazion where the conjunctival surface and skin surface are both equally significant. The high mortality associated with sebaceous-cell carcinomas makes a good pathologic specimen allowing for accurate diagnosis essential. Partial-thickness eyelid biopsies, especially in cases of sebaceous carcinoma, may lead the pathologist to an erroneous, more benign, diagnosis and the clinician to a false sense of security. While many of the nonscarring alopecias may be diagnosed on their clinical characteristics alone, the scarring alopecias will frequently need a lid biopsy to ascertain diagnosis and gauge treatment.