3: Eyelids- Malignant Lesions Flashcards
signs of skin cancer: ABCDE rule
-Asymmetry: one half does not match the other
-Borders: indistinct borders (uneven, scalloped, notching)
-Color: various colors within the lesion, may be amelanotic
-Diameter/Disruption: 6 mm (size of pencil eraser) or larger; disruption of normal eyelid architecture (e.g., madarosis, poliosis, swelling or thickening of the eyelid)
Evolving: any change in size, shape, color, or elevation; bleeding, itching or crusting; new mole after age 40
basal cell carcinoma
malignant tumor of the skin
basal cell carcinoma etiology
- proliferation of atypical basal epithelial cells
- associated with UV exposure
basal cell carcinoma demographics
- typically develops after the age of 50
- more common in Caucasians
basal cell carcinoma laterality
unilateral
basal cell carcinoma symptoms
- asymptomatic
- “bump” or mole, scab or “sore” on eyelid
basal cell carcinoma signs
- variable appearance
- pink, shiny, firm, pearly nodule with small overlying blood vessels
- centrally ulcerated with pearly raised rolled edges
- firm, waxy yellow plaque with indistinct borders
- open sore
- most frequently involves the LL and medial canthus > UL and lateral canthus
basal cell carcinoma complications
- orbital extension
- metastasis (extremely rare)
basal cell carcinoma management
- refer for biopsy and surgical excision
- Moh’s surgery: 98% curative
basal cell carcinoma clinical pearls:
- most common ____; 90% of cases involve ____ and ~10% of those involve _____
- most common ______; accounts for 90% of all cases
skin cancer;
head and neck;
the eyelid;
eyelid cancer/malignant tumor
squamous cell carcinoma
malignant tumor of the skin
squamous cell carcinoma etiology
- proliferation of atypical squamous epithelial cells
- associated with UV exposure, actinic keratosis, keratoacanthoma
squamous cell carcinoma demographics
- typically develops after the age of 50
- more common in Caucasians
squamous cell carcinoma laterality
unilateral
actinic keratosis (AK, solar keratosis)
- majority of SCC cases arise from actinic keratosis
- pre-malignant small dry, scaly, or crusty patches of skin; feel dry and rough to touch; painful, itchy, burning sensation
- may be red, light or dark tan, white, pink, flesh-toned, or a combination
- refer for biopsy, as 5-10% of AKs transform into SCC
keratoacanthoma
- pre-malignant variant of SCC
- clinically may resemble SCC and BCC
- characterized by rapid growth over a few weeks to months followed by slow regression and even spontaneous resolution in 4-6 months
- refer for biopsy and excision
squamous cell carcinoma symptoms
- asymptomatic
- “bump” or scab/sore on eyelid
squamous cell carcinoma signs
- variable appearance
- scaly red patch; may have crusting, scabbing, slight bleeding to margins
- rough, thickened, or wart-like skin
- raised growths with a central depression
- open sore
- most frequently involves the LL
squamous cell carcinoma complications
- orbital extension
- metastasis (high risk of metastasis)
squamous cell carcinoma management
- referral for biopsy and surgical excision
- Moh’s surgery (may not be curative, but a good start)
squamous cell carcinoma clinical pearls:
- most _____ of all eyelid cancers
- 2nd most common ______
- 2nd most common ______; accounts for 5-10% of all cases
variable in presentation;
skin cancer;
eyelid cancer
sebaceous gland carcinoma
malignant tumor of the sebaceous gland
sebaceous gland carcinoma etiology
proliferation of atypical epithelial cells lining sebaceous glands
sebaceous gland carcinoma demographics
typically develops after the age of 50
sebaceous gland carcinoma laterality
unilateral
sebaceous gland carcinoma symptoms
- asymptomatic
- “bump” in or on eyelid
sebaceous gland carcinoma signs
- variable appearance
- discrete hard nodule, yellow discoloration due to the presence of lipid
- may resemble benign lesions: recurrent, recalcitrant chalazion; recalcitrant hordeolum; chronic unilateral, recalcitrant blepharitis
- tends to spread along the conjunctival surface
- most frequently involves the UL (more sebacous/MGs in UL than LL!)
sebaceous gland carcinoma complications
- orbital extension
- metastasis (high risk of metastasis)
sebaceous gland carcinoma management
referral for biopsy and surgical excision
sebaceous gland carcinoma clinical pearls:
- can develop in _____; most often affects ____
- represents <1% of _____
- overall mortality is _____ due to _____
any sebaceous gland;
the meibomian glands;
all eyelid tumors;
5-10%; metastasis
melanoma
malignant tumor of the skin
melanoma etiology
- proliferation of atypical melanocytes
- develop from nevus
- associated with UV exposure
melanoma demographics
more common in Caucasians
melanoma laterality
unilateral
melanoma symptoms
- asymptomatic
- “bump” on eyelid; quick development (few weeks to few months); Hx of a nevus or mole, noticed change vs unaware
melanoma signs
- variable appearance
- flat or slightly raised and discolored, asymmetric patch with uneven borders
- variable size, but greater concern if >6 mm
- other malignant exam findings (ex: madarosis)
melanoma complications
metastasis: strong propensity with lymphatic invasion; orbital extension; may involve other organ systems
melanoma management
referral for biopsy and surgical excision
melanoma clinical pearls:
- can occur ____
- least common _____; represents 1% of all _____
- most _____ eyelid malignancy due to _____; accounts for the majority of _____
- 5-year survival rate is _____ if it is treated prior to metastasis; ____ if it spreads to the lymph nodes; _____ if spreads to distant body sites such as organs
anywhere on the skin; eyelid malignancy; eyelid tumors; fatal; metastasis; skin cancer deaths; 99%; 62%; 20%
Kaposi’s sarcoma
malignant tumor that usually appears on the skin or mucosal surfaces
Kaposi’s sarcoma etiology
proliferation of endothelial cells that line lymph or blood vessels in response to Kaposi sarcoma-associated herpesvirus (aka human herpesvirus 8, HHV-8)
Kaposi’s sarcoma demographics
- 4 types (defined by the population that acquire KS):
- AIDS associated KS
- Mediterranean KS
- African KS
- Transplant related KS
Kaposi’s sarcoma laterality
unilateral or bilateral
Kaposi’s sarcoma symptoms
- asymptomatic
- “bump” or plaque on the eyelid
Kaposi’s sarcoma signs
- purple, red, or brown nodule or papule
- can occur on the eyelid and/or conjunctiva
Kaposi’s sarcoma management
- refer out for treatment
- HAART (highly active antiretroviral therapy)
- if no improvement with HAART: surgical resection, radiotherapy, cryotherapy, intralesional chemotherapy
Kaposi’s sarcoma clinical pearls:
- can occur _____; most often affects _____
- no treatment available to eradicate _____, therefore, not cure for ____
- purpose of therapy is directed at _____
- KS is considered an AIDS defining illness
- infection with HHV-8 does not always lead to KS
anywhere on the skin or mucosal surfaces;
the legs and face;
HHV-8 infection;
KS;
improving cosmesis and slowing progression
