These are also called fibroepithelial polyps, acrochordons, or skin tags. They are very common, can have different sizes, can be protruding, occur as single units or as multiples, and present in the upper and lower lids as well as on the lateral sides of the eye. Sometimes they impair the field of vision; for some patients, they are of cosmetic concern. Cryotweezers are probably the best treatment option because they are painless, multiple lesions can be treated in one session, and there is no risk of hyperpigmentation because freezing is done only to the base of the lesion and no further. This is an important consideration because skin tags are very common in 3/5 skin types (Fig. 11.2a, b). Eyelid warts are also a form of squamous papilloma. They are very common and present as solitary with a filiform/digitated shape. These are best treated by grasping them with a cryotweezer until the freezing front reaches the bottom of the lesion. One cycle is sufficient. Larger lesions can be sprayed with LN.

These can be thin or thick, gray or brownish, or highly hyperpigmented, and there is usually a family tendency to present with them. They can be located anywhere in the lids (Fig. 11.3a, b) and sometimes occupy the lid margin (Fig. 11.4a, b), impairing the field of vision. Spraying with a small aperture should include a 1 mm margin of healthy skin to avoid ring-shaped recurrences or residual tumor. For lesions in the lid margin, it is best to use an appropriate size probe. The moisture in the area will help to fix the probe and control the advancing freezing zone. For those situations in which one desires to stop freezing and wants to detach the probe, a warm saline solution will do the job. One should not ever perform any forceful movements in the eyelid. The freezing with a fixed probe is best done when the patient is in a lying position.

In most dermatology reference books, keratoacanthomas are classified as well-differentiated squamous cell carcinomas. Eyelid keratoacanthomas are relatively frequent and have a typical dome-shaped appearance with a central crater or horn (Fig. 11.5). Cutaneous horns are classified by some as nonspecific keratosis. As a general recommendation, a biopsy of all cutaneous horns should be taken since some can have squamous cell carcinoma cells at the bottom. One technique that works very well for both lesions is to grab the lesion with a previously frozen cryotweezer and allow the freezing front to advance just to the bottom. Then shave the frozen block (for the histopathology study) and probe freeze the bottom of the lesion. By freezing the bottom part with a probe, any residual cells are destroyed and there will be no need for further treatment (Figs. 11.6a, b and 11.7a, b).