Childhood granulomatous periorificial dermatitis: Dermoscopy, reflectance confocal microscopy and histopathological correlations

angiosarcoma early. The initial finding in this case was bilateral periorbital swelling of both upper and lower eyelids. Besides direct tumour involvement, periorbital swelling may also be related to lymphoedema due to invading tumour masses causing blockade or compression of lymph ducts prior to other skin presentations. Previous reports of similar presentations showed only unilateral involvement. Due to swift tumour progression in this patient, bilateral periorbital swelling may indicate a poor prognosis. As lower eyelid swelling can be seen as a common process of aging, the involvement of both upper and lower eyelids should prompt further survey of systemic, inflammation, infection causes, such as thyroid diseases, ocular rosacea, allergies, and drug reactions, and malignancy. In conclusion, despite its rare occurrence, we believe bilateral periorbital swelling should be an important indicator for careful inspection of the scalp lesions for angiosarcoma, especially if the upper and lower eyelids are both involved. Further skin biopsy may be warranted for early diagnosis and treatment.