AED - Lumps and Bumps III - Week 3 Flashcards by B H

Can pigmented masses be found in the uvea?

Yesd

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Where does colouration of pigmented masses come from? What two layers is this found in?

Melanocytes found in connective tissue and basal layer

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Define naevus.

Benign acquired pigmentation

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Define melanosis and provide an alternate name. Describe what it looks like and what structure it involves.

Complexion associated melanosis
Found in dark-skinned individuals, usually flat and involved the limbus

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What does ocular melanocytosis look like and is it superficial or deep?

It is grey in the deep sclera

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List the 5 classifications of ocular pigmented lesions.

Naevus
Racial melanosis
Ocular melanocytosis
Primary acquired melanosis
Conjunctival melanoma

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What does the classification of naevus follow?

Uses different terms in different tissue

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What are conjunctival and skin naevus classified by? List them (3) and what theyre associated with.

By depth or cell type/appearance
-junctional (epithelial basal layer/stroma junction)
-intradermal (stromal)
-compound (stromal and epithelial)

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What is the most common conunctival tumour?

Naevus

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Are naevus consistently coloured or can they be patchy?

Can be patchy

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Are naevus mobile over the conjunctiva? What does this mean?

Yes, they havent ivaded below

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When do naevus typically form?

Pubescent years, 10-20 years of age

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Do naevus change with pregnancy?

They can

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Are naevus fast or slow growing? What percentage become malignant?

Very slow
<1% become malignant

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Are naevus flat or elevated?

Flat or minor elevation

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What are naevus typically close to?

Limbus

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Do naevus have a rich vascular supply?

No, 1-2 feeder vessels is common, its not rich

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What is present in 70% of naevus?

Cysts

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Can naevus be amelanotic?

Yes, complete or partial

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In which two types of naevus are biopsies done?

Junctional or compound

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What should you look out for with naevus (4)?

Sudden growth
Prominent feeders
Non-bulbar site
First noticed age 20+

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Is congenital melanocytosis benign or malignant?

Benign

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What is the cause of congenital melanocytosis?

Increased colour of deep tissue due to excess melanosomes

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What is the difference between congenital melanocytosis and naevus of ota?

If the pigment is on the eyes alone, it is congenital melanocytosis
If it includes the eye and skin, it is naevus of ota

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What appearance does congenital melanocytosis have? What percentage is associated with glaucoma? What percentage develops into melanoma?

Appears deep-bluish 10% can have associated glaucoma 2-4% develop melanoma

Does congenital melanocytosis involve the conjunctiva? Is it motile?

Doesnt involve the conjunctiva so it isnt motile

Does congenital melanocytosis change appearance or appear with puberty?

Can change or appear at puberty

Is primary acquired melanosis benign or malignant?

Premalignant

In what skin colour and age groups is primary acquired melanosis common?

Middle aged, fair skinned people

Is primary acquired melanosis uni- or bilateral?

Unilateral

Is the pigment of primary acquired melanosis dense or diffuse?

Diffuse

Is primary acquired melanosis a birthmark?

Where on the conjunctiva can primary acquired melanosis be found? Which regions especially?

Anywhere, especially the lid margins (evert lids)

Is primary acquired melanosis flat or raised?

Flat, not usually raised

What kind of proliferation is present in primary acquired melanosis? Is it mobile over the sclera? Does it have few or many feeder vessels?

Has lateral proliferation Is mobile over the sclera Has minimal feeder vessels

Is primary acquired melanosis diffuse or localised?

Diffuse (localised would be a naevus)

In what 3 cases is a biopsy indicated for a primary acquired melanosis?

Diffuse lesion found at the lid margin or the limbus with corneal involvement Expansive diffuse lesion in one eye

What is the chance of a future melanoma if there are pleomorphic cells in a primary acquired melanosis biopsy?

50%

What percentage of melanoma comes from primary acquired melanosis?

75%

Is melanoma invasive?

Yes

Is melanoma fast-growing?

Yes

Is the colouration of melanoma dense or diffuse?

Dense

Do melanoma have regular or irregular borders? What else is seen and what is it?

Irregular border Has a small halo which is the invasive region

What appearance does a melanoma have in terms of its surface?

Raised and irregular surface like a cauliflower

What can be seen on a biopsy of melanoma?

Invasive lesion with pleomorphism and anaplasia

Is a cavernous sinus fistula acquired or congenital?

Acquired

Is kaposi's sarcoma benign or malignant?

Malignant

What are the symptoms of kaposi's sarcoma?

None

List two signs of kaposi's sarcoma and where it is usually found.

Bright red vascular mass, most often inferior fornix May give sub-conjunctival haemorrhage

In what percentage of AIDS patients does kaposi's sarcoma occur?

25% due to immunocompromisation

What is telangiectasia and is it acquired or congenital?

Is congenital Dilated and tortuous blood vessels in the bulbar conjunctiva

Is telangiectasia common in isolation?

Not uncommon

List 7 important associations of telangiectasia.

Fabry's disease Bloom's syndrome Diabetes Ataxis telangiectasia Sturge-Weber syndrome Myeloid disorders Anaemic disorders

List 3 signs of sturge-weber syndrome.

Congenital conjunctival or episcleral haemangioma Episcleral or conjunctival involvement (70%) Cutaneous port wine stain along CNV

What three things may someone with sturge-weber syndrome also have?

Choroidal haemangioma Iris heterochromia Glaucoma before 2yo

What sign is classic of sturge-weber syndrome?

Port wine stain

What are the four components to assessing sturge-weber syndrome?

SL with lid eversion IOP Gonioscopy DFE

What should be considered for sturge-weber syndrome and why?

Referral for assessment of neurological status (intracranial haemangioma)

What does the presence of a choroidal haemangioma with sturge-weber syndrome predispose you to (2)?

Serous RD Glaucoma

List four symptoms of cavernous sinus fistula.

Weakness Dizziness Whooshing noise

List 5 signs of cavernous sinus fistula.

Generalised episcleral/conjunctival blood vessel dilation and tortuousity Elevated IOP on that eye Orbital bruit Lid oedema Retinal haemorrhage

What happens with a cavernous sinus fistula? How can it happen (2)?

ICA blood fills the cavernous sinus Can occur spontaneously or disease related (HT)

When is cavernous sinus fistulas common (2)?

After trauma or surgery

Should cavernous sinus fistulas be referred?

Yes urgently, for closure of fistula

How is cavernous sinus fistula managed (by an optometrist)?

Manage their IOP