[Keratoacanthoma of the eyelid area. Problems and risks in diagnosis and therapy]

Keratoacanthoma of the eyelid is a benign skin lesion. Because it regresses spontaneously observation without surgical intervention is the generally accepted method of management. This concept, which was developed in the sixties, is questioned on the basis of personal experience and a review of the literature. Recommendations for a rational management of the disease are suggested.

Two patients with clinically diagnosed eyelid keratoacanthomas are reported with their complicated disease course. A review of the dermatological and ophthalmic literature is presented.

For the correct diagnosis a sufficiently large and representative histological specimen is mandatory. The difficulty of differentiating between keratoacanthoma and squamous cell carcinoma is stressed. Surgery of advanced eyelid lesions is so much more destructive that early simple excision is advocated rather than a policy of initial observation.