Tuesday, June 2, 2015

A Patient with "Kissing" Naevus

Kissing naevus, also known as divided naevus, is a rare form of congenital anevus that usually occurs on adjacent parts of the upper and lower eyelids of one eye. When the eyelids are closed the eye appears to be covered by one large nevus. It may cause functional and aesthetic problems. This 60 year-old woman had had this lesion since birth and for the past three years there was an increase in size causing problem with eye opening. Examination shows no signs of malignant transformation. The patient was keen to have the lesion for both cosmetic and functional reasons. 

Picture 1. Left kissing naevus causing problem with
left eye opening and lower lid ectropion. 

The next series of photos show how the lesions were excised and the lids reconstructed. Before the operation, eye examination shows loose lower eyelid from chronic stretching of the lesion, so excision with direct closure was planned. The upper eyelid also showed lid stretching but it was thought the amount of excision may required additional steps to close the defect so reversed Tenzel's flap was planned. 

Picture 2. a. Drawings showing site of planned excision and reversed Tenzel flap. 
b. The lower lesion was excised in pentagon fashion. 
c, d and e. To facilitate direct closure, canthotomy and cantholysis of the lower eyelid were performed. 
f. Pentagon excision of the upper eyelid lesion.

Picture 2. g. At the end of excision; h. Layered closure of the lower eyelid; 
i. The cut edges of the upper eyelids can be apposed without tension so Tenzel flap was not done. 
j. Layered closure of the upper eyelid.

Picture 3. Appearance of the eyelid at the end of the operation. 

The excised lesions were sent for histopathologic study. The eyelid is expected to open in a few weeks time when the swelling subsides. (To be continued.

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