PALPEBRAL CUTANEOUS LEISHMANIASIS MIMICKING AN ADNEXAL TUMOR: DERMOSCOPY AT THE HEART OF THE DIAGNOSIS

Abstract

Background: Cutaneous leishmaniasis (CL) is a common infection in endemic areas and displays a wide clinical polymorphism that can mimic inflammatory, granulomatous, or tumoral lesions, particularly on the face. Eyelid involvement is rare and may be mistaken for a chalazion, an adnexal tumor, or a basal cell carcinoma, which can delay diagnosis. Case Presentation: We report the case of a 48-year-old man with no relevant medical history who presented with a slowly enlarging nodule of the right lower eyelid that had evolved over two months. Clinical examination revealed a solitary, well-defined, oval, erythematous-pink nodule measuring 1.5 cm, suggestive of a benign adnexal tumor or cutaneous leishmaniasis. Dermoscopy showed a diffuse erythematous background, shiny yellowish "tear-drop" structures, bright white starburst/chrysalis-like areas, and a polymorphous vascular pattern with irregular linear and dotted vessels. These features reoriented the diagnosis toward CL despite a negative smear, and a skin biopsy confirmed the diagnosis by revealing a granulomatous infiltrate containing Leishmania amastigotes. Conclusion: This case underscores the value of dermoscopy as a rapid, noninvasive tool that can redirect the diagnostic approach in atypical, pseudotumoral eyelid lesions and guide histological confirmation.