Adnexal Oncology Flashcards
What does adnexal mean?
From the latin “appendages”
- Orbit
- Eyelids
- Lacrimal Drainage System
Evereything around the eye which isnt the eye itself
How common are adnexal tumours?
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
What is a tumour?
Abnormal proliferation of tissue
What is a benign tumour?
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
What is a malignant tumour?
Anaplastic cells (loss of form or function)
Often repidly growing, capable of invading surrounding tissue and spreading to distant locations.
Colloquially known as “cancer”
Give some malignant tumour types
Carcinoma Sarcoma Lymphoma Leukaemia Blastoma
What is a Carcinoma?
Derived from epithelial cells (i.e. skin, respiratory, tract, GI tract)
What is a sarcoma?
Derived from connective tissue (i.e. bone, cartilage, fat, nerve)
What is a lymphoma?
Haemopoietic cells maturing in lymphatic tissue
What is leukaemia?
Haematopoietic cells maturing in blood
What is a blastoma?
Cancers derived from immature “precursor” cells or embryonic cells
List the benign eyelid tumours from common to rare
Squamous cell papilloma Basal cell papilloma (seborrhoeic keratosis) Melenocytic naevus Actinic Keratosis Pyogenuc Granuloma Keratoacanthoma Capillary Haemangioma Cavernous haemangioma
List the malignant eyelid tumours from common to rare
Basal cell carcinoma (90-95%)
Squamous cell carcimona (2-5%)
Sebaceous gland carcinoma (1-2%)
Melanoma (
Explain Squamous cell papilloma
- Pedunculated or sessile (broad based)
- Characteristic “raspberry” texture
- Usually viral
Treatment by excision or laser ablation
Explain basal cell papilloma = Seborrhoetic keratosis
- Greasy, brown, flat, round/oval
- Similar texture to squamous cell papilloma
- “Stuck on” appearance
- Unrelated to sun exposure
Rx = Excision
What is Melanocytic Naevus?
Composed of atypical melanocytes
Location of these melanocytes influences clinical appearance and potential for malignant transformation
What are the different types of Melanocytic Naevus
Junctional: Black
- Epidermis
- Most rare malignant transformation
Compound: Brown
-Deep epidermis
Intradermal:
- Grey - Papillary dermis
- Blue - Dermis
- —Malignant transformation rare
What is the early signs (+ concerning signs) of malignant transformation in Melanocytic Naevus?
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
What is pyogenic granuloma?
- Fast growing, higjly vascularised granuloma
- May follow surgery, infection, (trivial) trauma
- Erythematous pedunculated mass
Rx = Excision
What is Actinic Keratosis?
- 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)
What is Keratoacanthoma?
- 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
What is capillary haemangioma?
- 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
What is cavernous haemangioma?
- Rare, congenital
- Well demarcated pink patch
- Darkens with age, does not involute
- Sturge-weber
Rx = Laser
What are the epidemelogical features basal cell carcinoma?
- 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
What are features suggestive of Basal Cell Carcinoma?
- Slow, inexorable growth over months
- Usually non-pigmented, elevated, ulcerated
- Pearly, rolled, irregular border
- Telangiectasia
- Lack of tenderness
What are the clinical subtypes of Basal cell carcinoma?
Nodular
-Common, classic pearly nodule
Ulcerative:
-Common, may cause progress from nudular cucles of crusting and bleeding
Morphaeform/ infiltrative:
-Less common, indurated plaques
What is the surgical management of Basal cell carcinoma?
Standard excision
- Margin
- Primary vs delayed closure
Mohs surgery
What is the non-surgical management of basal cell carcinoma?
- Topical (imiquimod, efudex)
- Chemo (visodegib)
- Cryotherapy
- Radiotherapy
- Photodynamic therapy
What is squamous cell carcinoma?
- 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
What is a Sebaceous Gland carcinoma?
- “Recurrent chalazion”, “Unilateral blepharitis”
- Nodular, indurated lid margin
- Yellowish discolouration (lipid content)
- Pagetoid spread along conjunctiva
Rx = Excision
Malignant melanoma is rare on the eyelids.
What are the 3 types of cutaneous malignant melanoma?
Lentigo maligna
-Flat, variable pigmented macule
Superficial spreading
-Slightly raised pigmented plaque
Nodular
-Vertically invasive (may be amelanotic)
What should you remember when taking biopsies?
- 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
What is the rule of thumb for the excision margins of basal cell carcinoma?
- 3mm (96%) complete excision
- 2mm if small and tissue preservation is important
What is the rule of thumb for the excision margins of squamous cell carcinoma?
4mm margin
Discuss with MDT, consider MRI/Abdominal US
What is the rule of thumb for the excision margins of sebaceous gland carcinoma?
5-10mm margin
Consider sentinel node biopsy
What is the rule of thumb for the excision margins of malignant melanoma?
10-30mm margin depending on size
Consider sentinel node biopsy
What structures may be involved in an orbital tumour?
Lacrimal gland
Extrinsic eye muscles
Nerves
Blood vessels
List the benign orbital eye tumours from common to rare
Capillary haemangioma
Cavernous haemangioma
Pleomorphic adenoma
Optic nerve Glioma
