A woman has an elevated papule with a yellow–white multifaceted surface. What is this lesion?
A 35-year-old woman presented with a longstanding elevated papule (4 mm diameter) under her right medial lower eyelid (Figure 1). The pink papule was smooth and had a yellow–white multifaceted surface. Skin biopsy showed a nodule outlined by a rim of basaloid cells. The cells progressively became keratinised towards the centre of the nodule (Figure 2), forming hyaline sheets of keratin with small pale holes representing previous sites of nuclei (shadow cells).