2-31 Lid Lumps/Bumps

Question 1

General lid lumps/bump lesion risk factors?

Answer 1

• Caucasian
• Sun exposure
• Older males
• Smoking
• Immune-compromise

Question 2

Describe cyst of Zeis

Answer 2

• Sebaceous gland of zeis is blocked (Not same as exetrnal hordeolum)
• Benign
• Not translucent
• Exised under local anaesthetic

Question 3

Describe Cyst of Moll

Answer 3

• Moll’s glands are apocrine and associated w/ lashes
• Smooth, clear, fluid-filled cyst of sweat duct on lid margin
• Benign, surgically removed

Question 4

Describe apocrine hirdocystoma

Answer 4

• Like cyst of Moll, except not confined to lid margin
• Smooth, translucent
• Located along medial or lateral lid.
• Benign

Question 5

Describe sebaceous Cyst

Answer 5

Due to obstructed sebaceuous glands
- Can happen anywhere, but rarely so on lids
- Benign

Question 6

Describe xanthelasma

Answer 6

Yellowish subcutaneous plaques of cholesterol + lipid
- Slowly grows w/ time
- Associated w/ hyperlipidaemia sometimes
- Very common
- Affects middle-aged to elderly
- Can be removed for cosmetics

Question 7

Describe molluscum contagiosum

Answer 7

Pox virus infection of skin
- Wart-like lesions in skin + mucous membrane
- Direct contact transmission
- At eyelids, possible secondary chronic conjunctivitis + keratitis.
- Self-limiting sometimes.

Question 8

Describe squamous cell papilloma

Answer 8

Squamous epithelial hyperplasia
- Either pendunculated (irregular buldge w/ stalk) or sessile (flatter, attached to base w/o stalk)
- Common. Benign
- Asymptomatic
- Maybe pigmented

Question 9

Desribe seborrheic keratosis

Answer 9

A.K.A. basal cell papilloma
- Keratocyte proliferation at basal layer
- Common, benign, slow-growing
- W/ time, more pigmented + elevated
- Face + eyelids of elderly
- Excised Tx.

Question 10

Describe acitinic keratosis

Answer 10

Pre-cancerous skin lesion
- Proliferation of atypical keratinocytes in basal layer
- Can develop into sqaumous cell carcinoma
- Rarely on eyelids
- Flat, scaly lesion resulting from UV
- Cutaneous horn can arise
- Tx = exise, cryotherapy, or 5-Fluorouracil cream

Question 11

Describe cutaneous horn

Answer 11

Keratin accumulation
- Associated w/ both benign and malignant lesions

Question 12

Describe basal cell carcinoma
- General info
- 3 types?

Answer 12

• Most common malignancy
• Slow growing
• Elderly affected
• Locally invasive, limited metastasis potential
• Most common on lower lid due to light exposure
• Nodular
• Nodulo-ulcerative (rodent ulcer)
• Sclerosing

Question 13

Describe nodular BCC

Answer 13

Most common one
- Firm, shiny, vascularised nodule w/ central depression
- Slow growing, painless
- If untreated, destroys large part of eyelid

Question 14

Describe nodular-ulcerative BCC

Answer 14

“Rodent ulcer”
- Chornic central ulceration
- Raised rolled edges
- Bleed
- Telangiectatic margins
Can lead to eroding eyelid portion

Question 15

Describe sclerosing BCC

Answer 15

• May resemble chronic blepharitis (hard to diagnose)
• Less common
• Cannot delineate margins, feels bigger than it looks
• Spreads radially below normal epidermis

Question 16

Describe sqaumous cell carcinoma
- General info
- Appearance?

Answer 16

Squamous cell carcinoma
- More aggressive than BCC, can metastasise to lymph nodes nearby
- Mostly 70+ yr old males
- Can be indistinguishable from BCC
- Variable appearance
- Can come from actinic keratosis or de novo
- Usually lower lid.

Nodular:
- Hyperkeratotic nodule
- Can lead to crusting, erosions, and fissures
Ulcerating
- Well-delineated
- Central ulceration w/ hardened edges

Question 17

Describe sebaceous gland carcinoma
- general info
- appearance

Answer 17

• Rare, aggressive
• From meibomian glands, sebecous glands,or glands of Zeis
• 70 yrs avg
• Both lids possible
• Biopsy to confirm diagnosis
• Complete exision required.

Nodular:
- Discrete hard nodule
- Yellow discolouration (lipid presence)
- Mimics chalazion
Spreading:
- Infiltrate into dermis
- Lid margin thickening
- Loss/distorted lashes
- Mimics chronic blepharoconjuncitivitis (except it’s unilateral)

Question 18

• Melanoma is identified by what mnemonic?
• Tx
• Recording
• Clinical appearances?

Answer 18

A – Asymmetry
B – Borders irregular
C – Colour non-uniform
D – Diameter >6mm
E – Evolving in size, shape, or colour
- Aggressive Tx
- Note any ulceration/bleeds.

Nodular:
- Blue/black nodule surrouned by normal skin
- Aggressive
Superficial:
- More common
- Flat, multi-coloured lesions
- Can lead to raised nodule

Question 19

Describe Kaposi sarcoma

Answer 19

Vascular tumour
- Red-violet or brown
- Immune-deficiency Pxs
- Can distort lid (entropion, oedema, trichiasis)