Adnexal Oncology Flashcards by Andrew Hay

What does adnexal mean?

From the latin “appendages”

Orbit
Eyelids
Lacrimal Drainage System

Evereything around the eye which isnt the eye itself

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

What is a tumour?

Abnormal proliferation of tissue

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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”

How well did you know this?

Not at all

Perfectly

Give some malignant tumour types

Carcinoma
Sarcoma
Lymphoma
Leukaemia
Blastoma

How well did you know this?

Not at all

Perfectly

What is a Carcinoma?

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

How well did you know this?

Not at all

Perfectly

What is a sarcoma?

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

How well did you know this?

Not at all

Perfectly

What is a lymphoma?

Haemopoietic cells maturing in lymphatic tissue

How well did you know this?

Not at all

Perfectly

What is leukaemia?

Haematopoietic cells maturing in blood

How well did you know this?

Not at all

Perfectly

What is a blastoma?

Cancers derived from immature “precursor” cells or embryonic cells

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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 (

How well did you know this?

Not at all

Perfectly

Explain Squamous cell papilloma

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

Treatment by excision or laser ablation

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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