Abstract Listings 2025

Purpose

Cowden syndrome is a rare autosomal dominant condition caused by mutations within the PTEN suppressor gene. This condition is characterised by the development of hamartomas and is associated with an elevated risk of various malignancies. It is therefore key that clinicians maintain a high index of suspicion when assessing seemingly benign eyelid lesions in these high-risk patients. We hope that this results in improved prognosis and reduced incidence of late and incurable disease.

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Methods

A middle-aged female patient with a background of Cowden syndrome and Von Willebrand disease was referred by dermatology to oculoplastics for assessment of a wart-like lesion on the eyelid. Although clinical assessment of the lesion showed no concerning features, her genetic predisposition and elevated risk of malignancy was concerning. Additionally, her risk of perioperative bleeding was significant. These factors were considered and culminated in a cautious and multidisciplinary management plan.

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Results

The patient’s past medical history and increased cancer risk ultimately resulted in excision and biopsy being offered instead of a watchful waiting approach, more commonly adopted with similar lesions.

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Conclusion

This case emphasises the importance of careful risk stratification in complex oculoplastic patients. Although rare, such cases can have significant consequences if overlooked, further reinforcing the need for clinicians to remain vigilant when assessing high-risk individuals. This case also demonstrates the importance of a multidisciplinary team approach to complex patient care.

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Additional Authors

First name	Last name	Base Hospital / Institution
Mark	Awad	University Hospitals Dorset NHS Foundation Trust
John	Awad	Mid Cheshire Hospitals NHS Foundation Trust

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