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Anterior Segment Disease > 3: Eyelids- Benign Lesions > Flashcards

3: Eyelids- Benign Lesions Flashcards

1
Q

papule

A

a bump, palpable and circumscribed, elevated and less than 5 mm in diameter; may be pigmented, erythematous, or flesh-toned; example: elevated nevus (mole)

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2
Q

nodule

A

a lesion similar to a papule, with a diameter of 5 mm to 2 cm; may have a significant palpable dermal component; examples: fibroma, xanthoma, intradermal nevi

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3
Q

oculodermal melanocytosis (nevus of Ota)

A

hyperpigmentation of the eyelid, sclera, and uvea

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4
Q

oculodermal melanocytosis (nevus of Ota) etiology

A
  • proliferation of melanocytes

- congenital

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5
Q

oculodermal melanocytosis (nevus of Ota) demographics

A
  • most commonly affects Asian and African descent

- women > men

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6
Q

oculodermal melanocytosis (nevus of Ota) laterality

A

unilateral

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7
Q

oculodermal melanocytosis (nevus of Ota) symptoms

A
  • asymptomatic

- gray, blue, or black area on eyelid

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8
Q

oculodermal melanocytosis (nevus of Ota) signs

A
  • gray, blue, or black eyelid and/or facial hyperpigmentation (hyperpigmentation of the skin frequently follows the distribution of CN V1 and CN V2)
  • patchy but extensive slate-gray or blue scleral hyperpigmentation
  • variable amounts of uveal hyperpigmentation (darker iris, increased pigment in the angel, darker fundus)
  • may have iris mammillations
  • diffuse iris nevus
  • scleral or choroidal melanocytosis most common
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9
Q

oculodermal melanocytosis (nevus of Ota) complications

A
  • secondary open angle glaucoma (pigment blocks the TM)

- malignant potential, may evolve to melanoma (most common melanoma is uveal)

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10
Q

oculodermal melanocytosis (nevus of Ota) management

A
  • monitor for glaucoma (ONH evaluation with DFE, OCT, GCC, HVF 24-2)
  • monitor for melanoma (SL exam, ASeg photos)
  • if symptomatic/cosmesis, refer out for laser therapy for skin discoloration (may cause scarring, hyperpigmentation may recur)
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11
Q

oculodermal melanocytosis (nevus of Ota) clinical pearls:

  • _____ are least likely to have condition, but most likely to develop melanoma
  • if only the sclera and uvea is involved, known as _____ (same risk for glaucoma and transformation into uveal melanoma)
  • if only the sclera is involved, known as _____ (typically bilateral, small patches of slate-gray scleral pigmentation; benign condition)
A

Caucasians;
ocular melanocytosis;
scleral melanocytosis

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12
Q

xanthelasma

A

benign, lipid-laded plaques at the level of the dermis on the eyelids

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13
Q

xanthelasma etiology

A

may be associated with hyperlipidemia/hypercholesterolemia

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14
Q

xanthelasma demographics

A

typically occurs over the age of 40

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15
Q

xanthelasma laterality

A

bilateral&raquo_space; unilateral

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16
Q

xanthelasma symptoms

A
  • asymptomatic, cosmesis

- yellow plaques around the eyes

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17
Q

xanthelasma signs

A
  • multiple&raquo_space; singular, soft yellow plaques

- typically involves the medial canthus upper eyelids > lower eyelids

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18
Q

xanthelasma management

A
  • monitor if asymptomatic
  • if symptomatic (cosmesis), consider scope of practice for removal vs. referral out for removal (size); surgical excision, cryotherapy, laser treatment, chemical cauterization; potential for recurrence, suggests uncontrolled hypercholesterolemia
  • if no previous diagnosis of hypercholesterolemia and patient is under 40, consider ordering lipid panel or refer to PCP
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19
Q

port-wine stain (nevus flammeus)

A

benign, dilated capillaries in the dermis

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20
Q

port-wine stain (nevus flammeus) etiology

A
  • congenital

- may be associated with Sturge-Weber syndrome (if hemifacial dermatome pattern, think Sturge-Weber)

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21
Q

port-wine stain (nevus flammeus) demographics

A

present at birth

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22
Q

port-wine stain (nevus flammeus) laterality

A

unilateral > bilateral

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23
Q

port-wine stain (nevus flammeus) symptoms

A

red birthmark, cosmesis

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24
Q

port-wine stain (nevus flammeus) signs

A
  • flat, smooth, pink patch (can thicken and darken to a more purple color over time)
  • grows proportionately with the child
  • tends to follow dermatomal distribution
  • lesion is more prone to bleeding if scratched or injured
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25
Q

port-wine stain (nevus flammeus) management

A
  • none if asymptomatic
  • if symptomatic, refer out for laser surgery (causes the capillaries to burst, leads to gradual lightening, multiple laser treatments are necessary, cannot completely remove the lesion)
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26
Q

port-wine stain (nevus flammeus) clinical pearls:

-can occur _____

A

anywhere on the skin; tend to appear on one side of the face, head, and neck, but may also affect the abdomen, legs, or arms

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27
Q

Sturge-Weber syndrome

A
  • congenital neurological disorder caused by a gene mutation
  • features include facial port wine stain, choroidal hemangioma, intracranial vascular abnormalities, unilateral glaucoma (due to increased venous pressure)
  • port-wine stain that involves V1 and V2 is more likely associated with Sturge-Weber
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28
Q

capillary hemangioma

A

benign vascular tumor

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29
Q

capillary hemangioma etiology

A

proliferation of vascular endothelial cells

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30
Q

capillary hemangioma demographics

A

apparent during first few months of life (usually 3-6 months)

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31
Q

capillary hemangioma laterality

A

unilateral

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32
Q

capillary hemangioma symptoms

A

red or blue area on eyelid

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33
Q

capillary hemangioma signs

A
  • cutaneous lesion (bright red nodule; blanch with pressure)
  • subcutaneous lesion (bluish discoloration underneath normal skin)
  • enlarge and/or change color with crying
  • ptosis
  • induced astigmatism
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34
Q

capillary hemangioma complications

A

amblyopia (refractive or deprivation)

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35
Q

capillary hemangioma management

A
  • monitor for regression (~75% of lesions will resolve over 4 years)
  • correct refractive error
  • if visual obstruction or astigmatism leading to amblyopia or severe cosmesis, refer out for treatment (propranolol is treatment of choice; topical beta-blocker can be tried for small lesions; oral or injectable steroid; laser photocoagulation)
36
Q

capillary hemangioma clinical pearls:

  • can occur _____
  • enlarge rapidly over _____, then regress over _____
A

anywhere on the body; ocular involvement includes the eyelids, conj, and orbit;

weeks to months; months to years

37
Q

conjunctival capillary hemangioma

A

bright red nodule on the conj; similar treatment to eyelid hemangioma

38
Q

orbital capillary hemangioma

A

proptosis; MRI or CT scan to confirm diagnosis; similar treatment to eyelid hemangioma

39
Q

epidermoid cyst (epidermal inclusion cyst)

A

benign, superficial cyst filled with keratin

40
Q

epidermoid cyst (epidermal inclusion cyst) etiology

A
  • surface skin cells (epidermal tissue) move deeper into the skin (the dermis) and multiply forming a wall; these cells secrete keratin which fills the cyst
  • congenital or acquired; likely a result of trauma to the skin (past surgery, laceration, etc.)
41
Q

epidermoid cyst (epidermal inclusion cyst) demographics

A

no predilection

42
Q

epidermoid cyst (epidermal inclusion cyst) laterality

A

unilateral or bilateral

43
Q

epidermoid cyst (epidermal inclusion cyst) symptoms

A
  • asymptomatic, cosmesis

- “bump” or cyst on eyelid

44
Q

epidermoid cyst (epidermal inclusion cyst) signs

A
  • flesh-colored or yellow-white elevated, mobile, smooth papule or nodule; white color most common in newer-onset cyst; becomes darker as keratin incorporates dead skin cells
  • NOT translucent!
  • surrounding inflammation if cystic wall ruptures within the skin
45
Q

epidermoid cyst (epidermal inclusion cyst) management

A
  • surgical excision for removal
  • unmanaged can slowly progress until ruptures
  • cystic wall needs to be removed to prevent recurrence
46
Q

epidermoid cyst (epidermal inclusion cyst) clinical pearls:

  • can occur ____
  • multiple, tiny, superficial epidermoid cysts are called ____
A

anywhere on the skin;

milia

47
Q

sebaceous cyst

A

benign, superficial cyst filled with sebum

48
Q

sebaceous cyst etiology

A
  • blockage of a sebaceous gland with retention of sebum
  • if located on the eyelid margin, called a cyst of Zeis
  • likely a result of trauma to the skin
49
Q

sebaceous cyst demographics

A

no predilection

50
Q

sebaceous cyst laterality

A

unilateral or bilateral

51
Q

sebaceous cyst symptoms

A
  • asymptomatic, cosmesis

- “bump” on eyelid

52
Q

sebaceous cyst signs

A
  • flesh-colored to yellow papule or nodule (dome-shaped bump)
  • surrounding inflammation if cystic wall ruptures within the skin
53
Q

sebaceous cyst management

A
  • none if asymptomatic; may spontaneously regress

- surgical excision for removal; cystic wall needs to be removed to prevent recurrence

54
Q

sebaceous cyst clinical pearls:

-can occur _____

A

anywhere on the skin (called a cyst of Zeis if it is located on the eyelid margin!)

55
Q

sudoriferous cyst (hidrocystoma)

A

benign, superficial cyst filled with sweat

56
Q

sudoriferous cyst (hidrocystoma) etiology

A
  • blockage of a sweat gland with retention of sweat
  • eccrine= adnexal, apocrine= canthi/hair follicle
  • likely a result of friction, mechanical trauma to the skin
57
Q

sudoriferous cyst (hidrocystoma) demographics

A
  • no predilection

- can be more common with sweaty conditions, heat, and humidity

58
Q

sudoriferous cyst (hidrocystoma) laterality

A

unilateral or bilateral

59
Q

sudoriferous cyst (hidrocystoma) symptoms

A
  • asymptomatic, cosmesis
  • “bump” on eyelid
  • itching, discomfort
  • Hx of increase in size over weeks to months
  • Hx of previous drainage, either spontaneously or by practitioner
60
Q

sudoriferous cyst (hidrocystoma) signs

A
  • flesh-colored, round, mobile papule or nodule (dome-shaped bump); translucent and transilluminates*
  • surrounding inflammation if cystic wall ruptures within the skin
61
Q

sudoriferous cyst (hidrocystoma) management

A
  • none if asymptomatic; educate pt on cycle of regression and recurrence
  • surgical excision for removal; cystic wall needs to be removed to prevent recurrence (still a chance of recurrence after removal); incision and drainage is no longer considered adequate Tx
62
Q

sudoriferous cyst (hidrocystoma) clinical pearls:

  • highly _____
  • can occur _____; if located on the eyelid margin it is _____
  • multiple, tiny hidrocystomas are called _____; most common on ______
A 
recurrent;
anywhere on the skin;
apocrine aka a cyst of Moll;
syringoma;
cheeks and lower eyelids
63
Q

squamous papilloma (papilloma, skin tag)

A

benign epidermal tumor

64
Q

squamous papilloma (papilloma, skin tag) etiology

A
  • proliferation of squamous epithelial cells overlying a fibrovascular core; variable degrees of hyperkeratosis (irregular keratinized stratified squamous epithelium covering the epidermis)
  • may be a response to a viral infection; most commonly HPV; aka verruca vulgaris if viral
65
Q

squamous papilloma (papilloma, skin tag) demographics

A
  • if associated with HPV, young adults are more commonly affected
  • if non-viral, typically develops after the age of 40
66
Q

squamous papilloma (papilloma, skin tag) laterality

A

unilateral or bilateral

67
Q

squamous papilloma (papilloma, skin tag) symptoms

A
  • asymptomatic, cosmesis
  • “bump” or “stalk” on eyelid
  • irritation of the bump (e.g., tenderness, itching) with manipulation
68
Q

squamous papilloma (papilloma, skin tag) signs

A
  • flesh-colored or hyperpigmented papule or nodule (dome-shaped bump); pedunculated (containing a stalk) or sessile (no stalk); rough or smooth surface
  • surrounding inflammation if rubbed constantly (from clothes, picking)
69
Q

squamous papilloma (papilloma, skin tag) management

A
  • none if asymptomatic; may spontaneously regress/fall off; chance of recurrence if not excised
  • surgical excision for removal; entire lesion needs to be removed or may recur, esp. if viral etiology
70
Q

squamous papilloma (papilloma, skin tag) clinical pearls:

  • can occur ______
  • most common ______
A

anywhere on the skin, frequently develops in skin folds (e.g., neck, eyelids);
benign eyelid lesion

71
Q

seborrheic keratosis

A

benign epidermal tumor

72
Q

seborrheic keratosis etiology

A

proliferation of basal epithelial cells with keratin filled invaginations

73
Q

seborrheic keratosis laterality

A

unilateral or bilateral

74
Q

seborrheic keratosis symptoms

A
  • asymptomatic, cosmesis
  • “bump” or “scab” on eyelid/adnexa
  • irritation of the bump (e.g., tenderness, itching) with manipulation
75
Q

seborrheic keratosis signs

A
  • hyperpigmented papule or nodule (dome-shaped bump); slightly elevated from the skin with a stuck-on appearance; rough or smooth surface; waxy and granular to velvety texture
  • surrounding inflammation if rubbed constantly (mainly from clothes)
76
Q

seborrheic keratosis management

A
  • none if asymptomatic; may spontaneously regress; chance for recurrence with or without Tx
  • surgical excision for removal; curretage/scraping, cryotherapy, chemical cautery, cautery, laser
77
Q

seborrheic keratosis clinical pearls:

  • can occur ____
  • if multiple papules on the face, called ____; more common with _____
  • name is a misnomer; it is not _____
A

anywhere on the skin;
papulosa nigra;
African Americans and Asians;
seborrheic (relating to excessive discharge of sebum from sebaceous glands)

78
Q

melanocytic nevus (mole)

A

benign epidermal/dermal tumor

79
Q

melanocytic nevus (mole) etiology

A
  • proliferation of melanocytes
  • junctional: melanocytes clump at the epidermal/dermal junction
  • compound: melanocytes extend from the epidermis into the dermis
  • intradermal: melanocytes clump within the dermis; most common
  • associated with UV exposure
80
Q

melanocytic nevus (mole) demographics

A
  • often appear during puberty

- more common in Caucasians

81
Q

melanocytic nevus (mole) laterality

A

unilateral or bilateral

82
Q

melanocytic nevus (mole) symptoms

A
  • asymptomatic

- “bump” or mole, “dark spot” on eyelid

83
Q

melanocytic nevus (mole) signs

A
  • uniformly pigmented macule (flat lesion), papule, or nodule (dome-shaped bump)
  • most commonly tan, brown, or black; rarely, can be a blue nevus
  • may be amelanotic (pink)
  • most common location in regards to the eyelid is on the margin
  • flat or slightly elevated
84
Q

melanocytic nevus (mole) complications

A

-malignant potential- most important sign is documented change (however, may increase in size during puberty)

85
Q

melanocytic nevus (mole) management

A
  • monitor for melanoma: SL exam, ASeg photos

- surgical excision for removal; biopsy for suspicious lesions

86
Q

melanocytic nevus (mole) clinical pearls:

  • can occur _____
  • use ____ to confirm benign lesion
  • use _____ to catch change over time/potential malignant development
A

anywhere on the skin;
pertinent negatives;
pertinent malignant descriptors

Anterior Segment Disease (22 decks)

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