Treatment of Congenital Divided Nevus of the Eyelid with Excision and Blepharoplasty

437 Some cases of extensive bilateral xanthelasma palpebrarum have been reported. In those cases, similar to our case, soft and yellow plaques involved all four eyelids. The histopathologic findings were described well, but the treatment methods were not mentioned or almost all were laser ablations [2,3]. Rohrich et al. [4] suggested current management principles for xanthelasma palpebrarum. An algorithmic approach to the treatment of xanthelasma includes surgical excision, laser ablation, and trichloroacetic acid. If the xanthelasma lesion is smaller than 3 mm and within the range of blepharoplasty incision, blepharoplasty or modified blepharoplasty can be performed. If the xanthelasma lesion is smaller than 3 mm and outside the range of blepharoplasty incision, direct elliptical incision, traditional trichloroacetic acid peel, or laser ablation can be used. If the xanthelasma lesion is larger than 3 mm, serial excision or laser ablation can be selected. If the xanthelasma lesion is hard, uncapping removal and closure can be performed when the lesion is outside the blepharoplasty incision. In the present case, a full-thickness skin graft was chosen instead of staged excision. Our case illustrates a rare case of xanthelasma palpebrarum that was bilateral, extensive or wide, circular, and had rapidly developed one year prior to treatment. There was no strong familial history of xanthelasma palpebrarum or hyperlipidemia. We removed the lesion only using surgical methods. Although the size of the lesion was larger than 4 mm, we performed a full-thickness skin graft with the excised normal skin, instead of serial excision, with the lesion on the same side. This resulted in a good matching skin color and texture, and no donor-site scarring.