Adnexal & Oncology Flashcards
What is adnexal?
Adnexal means appendages, medically it refers to orbit, eyelids and lacrimal system
What are the categories of Adnexal tumours? [2]
Eyelid
Orbital (including lacrimal)
What are the common types of benign eyelid tumours? [3]
Squamous cell Papilloma
Basal Cell Papilloma
What are the common types of malignant eyelid tumours? [4]
90-95% Basal Cell Carcinoma (Split into nodular, ulcerative & Infiltrative)
2-5% are squamous cell carcinoma
1-2% are sebaceous Gland Carcinoma
Malignant Melanoma
How we ddx between different benign eyelid tumours? [3]
Squamous cell papillomas may be pedunculated or sessile & have a raspberry texture
Basal Cell Papillomas are greasy, brown, flat and oval/round
Melanocytic Naevus are asymmetrical, irreuglar bordered, variegated in colour and growing.
How do we ddx between different types of malignant eyelid tumour? BCC, SCC, sebaceous gland ca
Basal cell carcinomas are non-pigmented & elevated with a pearly, rolled irregular border and telangectasia. Can be nodular, ulcerative or infiltrative
Squamous cell carcinoma is a scaly surface over thick plaque, growing in weeks rather than months and arises from pre-existing actinic keratosis (rough scaly patch from sun damage)
Sebaceous gland Carcinomas are yellowish due to lipid content and cause blepharitis and recurrent chalazion
What are blepharitis and chalazion?
Blepharitis - Inflammation around the edge of the eyelids
Chalazion is a swelling in the Meibomian glands due to blockage from inflammation
What structures can be involved in an orbital tumour? [3]
Lacrimal gland
Extrinsic Eye Muscles
Nerves, Blood Vessels
What are the common types of orbital tumours?
Benign [3]
Malignant [5]
Benign:
- Capillary, Cavernous Hemangioma
- Pleomorphic Adenoma
- Optic Nerve Glioma
Malignant:
- Lymphoma
- Rhabdomyosarcoma
- Lacrimal Gland Carcinoma
- Osteosarcoma, Liposarcoma
- Primary Melanoma
Blepharitis
Ax
Presentation [3]
Mx [4]
Lid margin inflammation
Ax: staph, seborrheic dermatitis, rosacea
Sy/Si:
- bilateral grittiness
- redness, crusting, sticking in the morning with scales on lashes
- may also have assoc. conjunctivitis or keratitis
Mx:
Diluted baby shampoo, hot compresses, massage
Topical abx
Artificial tears
Lid hygiene
Styes
Types [2]
Mx
Hordeolum externum: staph infection or abscess in lash follicle that may also involve glands of Mall (sweat) and Zeis (sebaceous), pointing outwards
Hordeolum internum: abscess of Meibomian gland, points inwards
Mx: hot compress for 5-10 min several times a day
Chalazion
Ax
Presentation [2]
Mx [2]
Ax: chronic inflammation of Mebomium gland
Presentation:
- Painless (unless recurrently inflamed or infected
- Granular mass
Mx:
- surgical incision and curettage, intra-lesion steroid injection
Dermatitis
Ax [2] Mx [2]
Ax: cosmetics, eye drops
Mx:
- Avoidance
- Topical steroids
Ophthalmic shingles
Ep, Ax, pathophysiology [2], risk factors [3]
Ep:>50y/o
Ax:re-activation of varicella zoster virus
Px:after chickenpox, VZV lies dormant in sensory ganglia until becomes reactivated and spreads across dermatome
RF:increasing age, immunocompromised, trauma to affected area
Ophthalmic shingles
Presentation [3]
Mx and timing [2]
Sy/Si:
- vesicular rash in ophthalmic division of CN V
- pain and systemically unwell
- nasociliary branch involvement (nose tip = Hutchinson’s sign)
Mx:
- oral ACICLOVIR (more effective if given before vesicles crust reduces incidence of post-herpetic neuralgia and uveitis complications)
