AED - Lumps and Bumps IV - Week 4 Flashcards
Briefly describe the anatomy of the following glands:
Zeis
Moll
Meibomian
Wolfring
Krause
Describe each of them in terms of where they are found in the eyelid and, in order of anterior to posterior, where their openings are.
Zeis - sits at the base of the eyelash, most anterior
Moll - small gland whose opening is found between Zeis and Meibomian
Meibomian - opening found in the middle of the eyelid margin base, the gland extends superiorly throughout the tarsal plate in a line
Wolfring - the gland is found superior to the Meibomian gland, and opens onto the superior bulbar conjunctiva from inside the eyelid
Krause - gland and opening found at the fold between the tarsal and bulbar conjunctiva deep within the eyelid
Is the gland of Moll a hair follicle?
Yes
What is an inclusion cyst? Is it hard or soft? Is it translucent or not?
An entrapment of epithelial cells that secrete
Harder than fluid filled and not translucent
Can inclusion cysts be conjunctival?
Yesd
How does a cyst of moll appear? Is the fluid clear and is the cyst itself translucent or not?
It is a swelling at the lid margin, with clear fluid inside, and appears like a translucent balloon
Describe what milia look like and why they appear.
They are keratin cysts that appear as multiple hard pimples
Can sweat glands be blocked and form cysts?
Yes, multiple flat lesions or a very large balloon about the eye with milky fluid
Are cysts of Zeis and Moll tender?
No
What do Zeis cysts contain? What colour?
Contains fat, slightly yellow/white
Are Zeis cysts painful?
No
Are Zeis cysts opaque or translucent? What about Moll cysts?
Zeis are opaque, Moll are translucent
Do Zeis cysts contain a lash?
Yesd
Is a stye or hordeolum tender/painful?
Yes
What is a stye/hordeolum?
Infection of the gland of Zeis
How are styes and hordeolums managed? What about if they dont go away?
Warm compresses, most resolve within 2-3 days
Topical broad spectrum antibiotics can be used if persistent
How does a chalazion form?
Chronic bacterial activity at the opening of a meibomian gland results in blockage and buildup of meibomian secretion, which appears as a bump in the eyelid.
Are chalazions painful?
No
Are chalazions typically uni- or bilateral?
Unilateral
Are chalazions typically recurrent?
Yesd
Over what period of time do chalazions develop?
Several weeks
Are chalazions firm or soft?
Firm
In what three conditions are chalazions common?
Blepharitis
Acne rosacea
Seborrhoeic dermatitis
What kind of inflammation occurs in chalazions?
Chronic granulomatous inflammation
What are the four main cell types seen in the inflammation occuring ith chalazions?
Plasma cells
Neutrophils
Lymphocytes
MN giant cells
How would you rule out a sinister lesion with a case of chalazion?
Check for blood vessel feeders
What happens to chalazions eventually?
Spontaneous resolution in a few months when fluid is resorbed
What are two general treatment options for chalazion treatment? What about if it is recurrent?
Heat compresses and lid massages
Tetracycline if recurrent
What is a treatment option for long-lasting chalazions?
Incision with currettage
Steroid injection
In which gender and age group is sebaceous gland carcinoma more common in?
Elderly females, upper eyelid
List 4 signs of sebaceous gland carcinoma.
Chronic non-healing blepharitis
Multi-lobed, red/irritated, recurrent mass for months to years
Loss of lashes and eyelid structure
What does a sebaceous gland carcinoma resemble?
Long lasting chalazion
What is a verruca?
Viral wart
What are the two forms of verruca?
Small papule with a lumpy surface and broad base
Elongated filiform
What virus is responsible for causing molluscum contagiosum? What appearance does this infection have?
Viral infection caused by pox virus
A wart-like lesion but less prominent - dome shaped papule
List 4 symptoms of molluscum contagiosum. Can it be asymptomatic?
Mild photophobia
Lacrimation
VA drop
Hyperaemia
Can be asymptomatic
How is molluscum contagiosum managed (2)?
Counsel goo hygiene
Refer large lesions for excision
What appearance does a keratoacathoma have?
A raised nodule with a central crater, resembling a volcano
Do keratoacanthoma have a halo?
No
In what age population is a keratoacantoma more likely?
Middle aged/eldery
What is a risk factor for keratoacanthoma?
Sun-damaged skin
What is found at the centre of a keratoacanthoma?
Keratin core
How does a keratoacanthoma grow?
Grows rapidly initially over 2-6 weeks
What is the management for keratoacanthoma?
Refer for excision and biopsy
How would SCC be excluded for a suspected case of keratoacanthoma (2)?
Crater and halo
Find the keratin core with biopsy
What is a xanthelasma?
Benign, lipid filled tumour
How does xanthelasma appear?
Soft yellowish plaques
Are xanthelasma uni- or bilateral? Are they found medially on the eyelid or temporally?
Often bilateral, on the medial aspect
What do xanthelasma follow?
The folds of skin
Are xanthelasma permanent? Do they grow rapidly?
Often permanent and grow slowly
What age group is more likely to get xanthelasma?
Middle aged / elderly
In what two conditions may xanthelasma occur?
Hypercholesterolaemia and lipoprotein disorders
How are xanthelasma managed (2)?
Refer to GP for systematic lipid profile
Consider referral for excision for cosmesis if recurrent and biopsy
What is seborrhoeic keratosis?
A benign epithelial tumour
Are seborrhoeic keratoses symptomatic or aymptomatic?
Usually asyptomatic
What are seborrheic keratoses caused by?
UV damage
How long are seborrheic keratoses present for?
Months to years
Can seborrheic keratoses grow larger?
They may slowly
Are seborrheic keratoses common or rare before 30yo?
Rare
How does seborrheic keratosis appear?
Small hard lesion above the skin surface which may be rough
What happens with seborrheic keratosis histologically (2)?
Proliferation of basal epidermal cells
Keratin filled cysts
What is the management for seborrheic keratosis?
Referral for excision, biopsy if suspicious
What is solar or actinic keratosis?
Benign skin tumour
How do solar/actinic keratoses appear?
Rough/scaly elevated lesion
Can solar/actinic keratoses be malignant?
Yes there is poetential
How are solar/actinic keratoses managed?
Refer for excision or biopsy as needed
What is the histopathological difference between skin naevus and moles?
Same, but moles are small, naevus are larger
Are skin naevus colourations even or uneven?
Even
Are skin naevus flat or elevated?
Can be either
Are skin naevus pigmented or unpigmented?
Can be either
Which layer of skin are skin naevus typically found (3)?
Epidermis, dermis, rarely deeper (appears blue)
What is the most common type of skin naevus?
Intradermal
When do skin naevus appear?
Appears at puberty
How can a skin naevus be distinguished from a malignant melanoma (9)?
Melanoma are:
Raised nodule or plaque
Has an active halo and variable in colour
Increased size/thickness
Irregular edges
Inflammation
Bleeding
Satellite lesions
Growth and rapid change
How can a suspected malignant melanoma be managed?
Take yearly photos and watch closely
Refer for biopsy/excision if at all suspicious
