Case of the Month

A 62-year-old man presents a dark mole on his abdomen. Diagnosis: seborrheic keratosis. During his examination I notice strange yellow-orange spots on his eyelids. When I asked him about these spots he was completely unaware that they are even there!

What's your diagnosis?

Diagnosis: Orange Palpebral Spots

At first I thought they were a variant/type of xanthelasma. But the clinical look/examination didn’t quite fit. They were completely flat and really orange. One colleague suggested that he had eaten Cheetos and wiped his fingers on his eyelids just before coming to the office! The patient was both curious and worried and allowed me to do a biopsy. Pathology (micrograph and read-out done by Erick Jacobson-Dunlap, MD, dermatopathologist extraordinaire) indicated: “Epidermal atrophy with prominent adipose tissue”.

The yellow-orange color represents the fat, as seen through the thin epidermis. (I wonder if there is an optical effect enhances the yellow-orange color like the Tyndall effect enhances/reflects blue colors?)

After some searching, this rare occurrence (Orange eyelid spots) has been well documented. Please see the references below.

I assured the patient that the orange eyelid spots were harmless and that no additional treatment was needed.

References
AOCD.org
https://www.aocd.org/page/OrangePalpebralSpots
Medical Journals
https://www.medicaljournals.se/acta/content/html/10.2340/00015555-0910
NCBI
https://www.ncbi.nlm.nih.gov/pubmed/18216481
Karger
https://www.karger.com/Article/PDF/111516