Black Birthmarks on the Lower Eyelid: Risks and Treatment Options

Black nevus on the lower eyelid?

Hello doctor, I have had a black nevus on the lower eyelid of my left eye since childhood, about the size of a fingernail, and it feels raised to the touch.
A few years ago, I consulted a dermatologist at a major hospital about the possibility of laser treatment to remove this nevus, but the dermatologist referred me to an ophthalmologist because it is too close to the eye.
The ophthalmologist indicated that excision would be necessary, but that there would still be a scar, just not a black one (the excised area would be filled with tissue from another part of the body).
It seems that complete removal without any trace is not possible.
In recent months, I have read that there is a risk of malignant transformation with black nevi, and many people suggest that a plastic surgeon might achieve a more aesthetically pleasing result.
Should I directly consult a plastic surgeon for this nevus? Is it likely that they can handle it in a way that minimizes scarring? Also, is there really a risk associated with its proximity to the eye that would prevent treatment? Lastly, if left untreated, is there a risk of malignant transformation in the future? Thank you.

Niming, 20~29 year old female. Ask Date: 2019/10/24

Dr. Wu Yuxin reply Dermatology

Recommendation for orthopedic surgery.

Reply Date: 2019/10/24

More Info

Hello! Thank you for your inquiry regarding the black birthmark on your lower eyelid. It’s understandable to be concerned about both the cosmetic and potential health implications of such a mark, especially when it’s located near the eye.

Firstly, it’s important to clarify what a black birthmark, or nevus, is. These marks are usually benign and can vary in size, shape, and color. However, when they are located on sensitive areas like the eyelids, special considerations must be taken into account regarding treatment options and potential risks.

From your description, it seems that the birthmark is raised and has been present since childhood. The fact that dermatologists and ophthalmologists have advised caution regarding treatment is not uncommon. The proximity of the birthmark to the eye raises concerns about potential complications during any procedure, such as laser treatment or surgical excision. The eye is a delicate organ, and any procedure carries risks, including infection, scarring, or even damage to the eye itself.

Regarding the treatment options, you mentioned that the dermatologists suggested laser treatment, but it was deemed too risky due to its location. Surgical excision is indeed a common approach for removing such lesions, but as you noted, it may leave a scar, albeit a less noticeable one. The healing process and the final appearance of the scar can vary significantly from person to person, depending on factors such as skin type, healing ability, and the skill of the surgeon.

You also raised a valid concern about the risk of malignant transformation of the birthmark. While most melanocytic nevi are benign, there is a small risk that they can undergo changes that may indicate malignancy, particularly if there are changes in size, shape, color, or if they become symptomatic (itching, bleeding, etc.). Regular monitoring by a healthcare professional is advisable to detect any changes early.

As for your question about consulting a plastic surgeon, this could be a reasonable next step. Plastic surgeons are trained in cosmetic procedures and may offer techniques that minimize scarring. They can assess the birthmark and discuss potential options for removal that balance cosmetic outcomes with safety. However, it’s crucial to ensure that the surgeon has experience with procedures involving the eyelid area, as this requires a specific skill set.

In terms of whether to proceed with treatment or leave the birthmark as is, this decision should be made based on a thorough discussion with your healthcare providers. If the birthmark is stable and not causing any functional issues, some individuals choose to leave it alone. However, if you are concerned about its appearance or potential for change, pursuing removal may provide peace of mind.

In summary, I recommend consulting with a board-certified plastic surgeon who has experience with eyelid procedures. They can provide a comprehensive evaluation and discuss the best options for your specific situation. Additionally, regular follow-ups with a dermatologist or ophthalmologist are essential to monitor the birthmark for any changes over time. Thank you for your question, and I hope this information helps you make an informed decision!

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