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H+N - C > Adnexal Oncology > Flashcards

Adnexal Oncology Flashcards

1
Q

What does adnexal mean?

A

From the latin “appendages”

  • Orbit
  • Eyelids
  • Lacrimal Drainage System

Evereything around the eye which isnt the eye itself

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2
Q

How common are adnexal tumours?

A

Eyelid tumours

  • Very common
  • Up to 20% of Caucasians in their lifetime

Lacrimal Drainage Tumours

  • Vanishingly Rare
  • Less than 1 per 1,000,000 per year

Orbital Tumours

  • Very rare
  • 2/3 benign, 1/3 malignant
  • Approximately 1 per 100,000 per year
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3
Q

What is a tumour?

A

Abnormal proliferation of tissue

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4
Q

What is a benign tumour?

A

Normal cells in abnormal numbers and/or location

Cells lack the ability to invade local tissue or to metastasise

Typically slow growing
Main problems from mass effect

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5
Q

What is a malignant tumour?

A

Anaplastic cells (loss of form or function)

Often repidly growing, capable of invading surrounding tissue and spreading to distant locations.

Colloquially known as “cancer”

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6
Q

Give some malignant tumour types

A 
Carcinoma
Sarcoma
Lymphoma
Leukaemia
Blastoma
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7
Q

What is a Carcinoma?

A

Derived from epithelial cells (i.e. skin, respiratory, tract, GI tract)

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8
Q

What is a sarcoma?

A

Derived from connective tissue (i.e. bone, cartilage, fat, nerve)

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9
Q

What is a lymphoma?

A

Haemopoietic cells maturing in lymphatic tissue

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10
Q

What is leukaemia?

A

Haematopoietic cells maturing in blood

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11
Q

What is a blastoma?

A

Cancers derived from immature “precursor” cells or embryonic cells

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12
Q

List the benign eyelid tumours from common to rare

A 
Squamous cell papilloma
Basal cell papilloma (seborrhoeic keratosis)
Melenocytic naevus
Actinic Keratosis
Pyogenuc Granuloma
Keratoacanthoma
Capillary Haemangioma
Cavernous haemangioma
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13
Q

List the malignant eyelid tumours from common to rare

A

Basal cell carcinoma (90-95%)

Squamous cell carcimona (2-5%)

Sebaceous gland carcinoma (1-2%)

Melanoma (

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14
Q

Explain Squamous cell papilloma

A
  • Pedunculated or sessile (broad based)
  • Characteristic “raspberry” texture
  • Usually viral

Treatment by excision or laser ablation

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15
Q

Explain basal cell papilloma = Seborrhoetic keratosis

A
  • Greasy, brown, flat, round/oval
  • Similar texture to squamous cell papilloma
  • “Stuck on” appearance
  • Unrelated to sun exposure

Rx = Excision

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16
Q

What is Melanocytic Naevus?

A

Composed of atypical melanocytes

Location of these melanocytes influences clinical appearance and potential for malignant transformation

17
Q

What are the different types of Melanocytic Naevus

A

Junctional: Black

  • Epidermis
  • Most rare malignant transformation

Compound: Brown
-Deep epidermis

Intradermal:

  • Grey - Papillary dermis
  • Blue - Dermis
  • —Malignant transformation rare
18
Q

What is the early signs (+ concerning signs) of malignant transformation in Melanocytic Naevus?

A 
Early signs of malignant transformation:
A- Asymmetry
B- Border (irregular)
C- Colour (Variegated)
D- Diameter (>6mm)
E- Evelving (growing)

Concerning
E- Elevated
F- Firm to touch
G- Growing

19
Q

What is pyogenic granuloma?

A
  • Fast growing, higjly vascularised granuloma
  • May follow surgery, infection, (trivial) trauma
  • Erythematous pedunculated mass

Rx = Excision

20
Q

What is Actinic Keratosis?

A
  • Common pre-malignant condition, though relatively rare on eyelids
  • Flat, scaly, hyperkeratotic skin, occasionaly fomes cutaneus horn
  • Related to sun exposure

Rx = Excision or medical traetment (resonds well to creams)

21
Q

What is Keratoacanthoma?

A
  • Rare, “squamous cell carcinoma in situ”
  • Rapidly growing in otherwise healty skin
  • Pink papule, hyperkeratotic crater
  • Sun exposure, immunosuppression
  • Often spontaneous involution after 2-3 months

Rx = Excision

22
Q

What is capillary haemangioma?

A
  • Although rare, one of the commonest tumours of infancy
  • Predilection upper lid +/- orbital extension
  • Amblyopia, astigmatism
  • Involution from age 2, 40% by 4, 70% by 7

Rx = Beta-blockers, intralesion steroid, surgery

23
Q

What is cavernous haemangioma?

A
  • Rare, congenital
  • Well demarcated pink patch
  • Darkens with age, does not involute
  • Sturge-weber

Rx = Laser

24
Q

What are the epidemelogical features basal cell carcinoma?

A
  • Commonest cancer worldwide
  • Pale skin and sun exposure
  • 70% occur on the face
  • > 100,000/year in UK
  • Will affect up to 20% of Caucasians in their lifetimes
  • Locally invasive, risk of metastasis about 1:1000
25
Q

What are features suggestive of Basal Cell Carcinoma?

A
  • Slow, inexorable growth over months
  • Usually non-pigmented, elevated, ulcerated
  • Pearly, rolled, irregular border
  • Telangiectasia
  • Lack of tenderness
26
Q

What are the clinical subtypes of Basal cell carcinoma?

A

Nodular
-Common, classic pearly nodule

Ulcerative:
-Common, may cause progress from nudular cucles of crusting and bleeding

Morphaeform/ infiltrative:
-Less common, indurated plaques

27
Q

What is the surgical management of Basal cell carcinoma?

A

Standard excision

  • Margin
  • Primary vs delayed closure

Mohs surgery

28
Q

What is the non-surgical management of basal cell carcinoma?

A
  • Topical (imiquimod, efudex)
  • Chemo (visodegib)
  • Cryotherapy
  • Radiotherapy
  • Photodynamic therapy
29
Q

What is squamous cell carcinoma?

A
  • Sun damaged skin and pre existing AK
  • Scaly surface over a thick plaque
  • Growth over weeks rather than months
  • Metastatic risk of 3-10%

Rx = Excision

30
Q

What is a Sebaceous Gland carcinoma?

A
  • “Recurrent chalazion”, “Unilateral blepharitis”
  • Nodular, indurated lid margin
  • Yellowish discolouration (lipid content)
  • Pagetoid spread along conjunctiva

Rx = Excision

31
Q

Malignant melanoma is rare on the eyelids.

What are the 3 types of cutaneous malignant melanoma?

A

Lentigo maligna
-Flat, variable pigmented macule

Superficial spreading
-Slightly raised pigmented plaque

Nodular
-Vertically invasive (may be amelanotic)

32
Q

What should you remember when taking biopsies?

A
  • Adequate size
  • Try to include area of normal tissue
  • Try not to crush or use excess cautery
  • Give histologist as much info as possible

Suspected MM

  • Excision biopsy with small margin
  • Go back to extend margin acording to Clark level or Breslow correlation of confirmed
33
Q

What is the rule of thumb for the excision margins of basal cell carcinoma?

A
  • 3mm (96%) complete excision

- 2mm if small and tissue preservation is important

34
Q

What is the rule of thumb for the excision margins of squamous cell carcinoma?

A

4mm margin

Discuss with MDT, consider MRI/Abdominal US

35
Q

What is the rule of thumb for the excision margins of sebaceous gland carcinoma?

A

5-10mm margin

Consider sentinel node biopsy

36
Q

What is the rule of thumb for the excision margins of malignant melanoma?

A

10-30mm margin depending on size

Consider sentinel node biopsy

37
Q

What structures may be involved in an orbital tumour?

A

Lacrimal gland
Extrinsic eye muscles
Nerves
Blood vessels

38
Q

List the benign orbital eye tumours from common to rare

A

Capillary haemangioma
Cavernous haemangioma
Pleomorphic adenoma
Optic nerve Glioma

H+N - C (17 decks)

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