Benign Lesions Flashcards
Xanthelasma
- What is it?
- What causes it?
Lipid depositions in the eyelids
May be associated with hypercholesterolemia
Xanthelasma
- Demographics
- Laterality
40+
Bilateral
Xanthelasma
Symptoms
Signs
No symptoms.
Yellow plaques around eyes. Soft. Usually involves the medial upper eyelids.
Xanthelasma
Management
None if asymptomatic
Could refer for removal but might recur
Send for lipid panel if not dx with high cholesterol
Port Wine Stain (Nevus Flammeus)
- What is it
- What causes it?
Dilated capillaries in the dermis. can occur anywhere on skin but tend to appear on one side of the face, head, neck, abdomen legs and arms.
congenital, may be associated with surge weber syndrome.
Port Wine Stain (Nevus Flammeus)
- Demographics
- Lateality
Present at birth
Unilateral > Bilateral
Port Wine Stain (Nevus Flammeus)
-Symptoms and signs
Red birthmark
Flat, smooth, pink patch. Can thicken and darken to a more purple color over time. Grows proportionally with the child and follows dermatomal distribution. More prone to bleeding if scratched.
Port Wine Stain (Nevus Flammeus)
Management
None if asymptomatic
Symptomatic, refer out for laser surgery that causes capillaries to burst–> Lightening. Multiple treatments necessary and may not completely resolve.
Sturge Weber Syndrome
Congenital neuro disorder caused by gene mutation.
Port wine stain, choroid hemangioma, vascular abnormalities, unilateral glaucoma due to increased venous pressure.
Port wine stain V1 and V2 are more likely associated with SWS
Capillary Hemangioma
- What is it?
- What causes it
Benign vascular tumor
Proliferation of vascular endothelial cells
*Can occur anywhere on the body.
Capillary Hemangioma
- Geographics
- Laterality
Apparent during 1st few months of life
Unilateral
Capillary Hemangioma
Symptoms
Signs
Red or blue area on eyelid. Ocular involvement includes eyelids, conj and orbit.
Conj- bright red nodule on conj. Tx similar to eyelid
Orbital- proptosis, MRI or CT scan to confirm. Tx similar to eyelid.
Cutaneous lesion- bright red nodule that blanches with pressure.
Subcutaneous lesion- blue under normal skin.
Enlarge and color change with crying
ptosis
Induced astigmatism
Capillary Hemangioma
Complications
Management
Amblyopia due to refractive error or visual deprivation
Monitor for regression. 75% resolve in 4 years. (Rapid enlargement over weeks to months at first, then regress)
Correct ref error
If visual obstruction, refer out.
Propanolol oral is treatment of choice. Or you could do topical timolol for small lesions.
Injectable steroid
Laser photocoagulation
Nodule
A lesion similar to papule.
5mm-2cm.
Fibroma, xanthoma, intradermal nevi
Epidermoid Cysts (Epidermal inclusion cyst)
- What is it
- Cause
Superficial cyst filled with keratin
Caused when surface skin cells move deeper into the skin and multiply, forming a wall. They secrete keratin which fills the cysts. Likely due to skin trauma.
Epidermoid Cysts (Epidermal inclusion cyst)
- Demographics
- laterality
No predilection
Unilateral or bilateral
Epidermoid Cysts (Epidermal inclusion cyst)
Symptoms
Signs
Symptoms- Asymptomatic, Bump on eyelid
Signs- Flesh colored or yellow/white papule or nodule. Dome shape bump. Surrounding inflammation if cyst ruptures.
Epidermoid Cysts (Epidermal inclusion cyst) Management
None if asymptomatic
May spontaneously regress
Surgical excision for removal. Cystic wall has to be removed to prevent recurrence.
Milia
Multiple, tiny superficial epidermoid cysts.
Sebaceous Cysts
- What is it
- What causes it
Superficial cyst filled with sebum. Can occur anywhere on the skin. If located on the eyelid margin, called cyst of Zeis
Blockage of sebaceous gland with retention of sebum, likely due to trauma
Sebaceous Cysts
Demographics
Laterality
No predilection
Unilateral or bilateral
Sebaceous Cysts
Symptoms
Signs
Asymptomatic or bump on eyelid
Flesh colored/yellow papule or nodule (dome shape)
Surrounding inflammation if cystic wall ruptures
Sebaceous Cysts
Management
None of asymptomatic, can regress.
Surgical excision. Cystic wall needs to be removed to prevent recurrence.
Sebaceous cyst that occurs on the eyelid margin is called
Cyst of Zeis
Sudoriferous Cyst (HIdrocystoma)
- What is it
- cause
Superficial cyst filled with sweat. Can occur anywhere on the skin
Cause- blockage of sweat gland w retention of sweat
Likely a result of trauma to the skin
Sudoriferous Cyst (HIdrocystoma)
Demographics
Laterality
No predilection
Unilateral or bilateral
Sudoriferous Cyst (HIdrocystoma)
Symptoms
Signs
Asymptotic, bump on lid
Flesh colored papule or nodule (dome shaped)
Translucent and transilluminates
Surrounding inflammation if cystic wall ruptures within the skin.
Sudoriferous Cyst (HIdrocystoma) Management
None if asymptomatic, may regress
Surgical excision for removal. Must remove cystic wall.
Sudoriferous Cyst (HIdrocystoma) located on eyelid margin is called
Cyst of Moll
Multiople, tiny Sudoriferous Cyst (HIdrocystoma) are called
Syringoma. Most common on cheeks and lower eyelids.
Squamous papilloma (papilloma, skin tag, verruca vulgaris if viral)
- What is it
- Cause
Benign epidermal tumor that can develop anywhere on the skin. Typically between skin folds- neck, eyelids.
Proliferation of squamous epithelial cells overlying a fibrovascular core. Variable degrees of hyperkeratosis.
May be a response to viral infection (HPV)
Squamous papilloma (papilloma, skin tag, verruca vulgaris if viral)
Demographics
Laterality
If associated with HPV, young adults more commonly affected.
Non viral- develops after the age of 40
Unilateral or bilateral
Squamous papilloma (papilloma, skin tag, verruca vulgaris if viral)
Symptoms
Signs
Symptoms- Asymptomatic, bump on eyelid, irritation of the bump if rubbed constantly (tender/itchy)
Signs- Flesh colored or hyper pigmented papule or nodule. Dome shape bump. Pedunculated (containing a stalk) or sessile (no stalk). Rough or smooth surface. Surrounding inflammation if rubbed.
Squamous papilloma (papilloma, skin tag, verruca vulgaris if viral) Management
None if asymptomatic, may regress.
Surgical excision for removal. Entire lesion needs to be removed or may recur if viral.
Most common benign eyelid lesion
Squamous papilloma (papilloma, skin tag, verruca vulgaris if viral)
Seborrheic Keratosis
- What is it
- Cause
Benign epidermal tumor **It is not seborrheic- relating to excessive discharge of sebum from sebaceous glands
Proliferation of basal epithelial cells with keratin filled invaginations.
Seborrheic Keratosis
- Demographics
- laterality
Typically develops after 40
Unilateral or bilateral
Seborrheic Keratosis
Symptoms
Signs
Symptoms- asymptomatic bump on eyelid. Can be irritated if rubbed constantly.
Signs- hyper pigmented papule or nodule (dome shape)
Slightly elevated from the skin with a “stuck on” appearance. Rough or smooth. Waxy.
Seborrheic Keratosis
Management
None of asymptomatic
May spontaneously regress
Surgical excision for removal
Multiple Seborrheic Keratosis papules on face is called
Dermatosis pupulosa nigra
More common with dark skin
Oculodermal Melanocytosis (Nevus of Ota)
- What is it
- Cause
Hyperpigmentation of the eyelid, sclera, and urea.
Cause- proliferation of melanocytes, congenital.
Oculodermal Melanocytosis (Nevus of Ota)
Demographics
Laterality
Asian and African descent. Caucasians least likely to have, but most likely to develop melanoma.
Women > men
Unilateral
Oculodermal Melanocytosis (Nevus of Ota)
Symptoms
Signs
Symptoms- Asymptomatic. Grey, blue or black area on eyelid.
Signs- gray, blue or black eyelid/facial hyperpigmentation. Frequently follows the distribution of CN V1 and V2.
Patchy, but extensive slate grey or blue scleral hyperpigmentation
Variable amounts of uveal hyperpigmentation
Darker iris, increased pigment in the angle, darker fundus.
May have iris mammillations.
Oculodermal Melanocytosis (Nevus of Ota) Complications
Secondary open angle glaucoma due to pigment blocking TM
Oculodermal Melanocytosis (Nevus of Ota) Management
Monitor for glaucoma
-IOP, gonio, ON pics, ON OCT, GCC, VF
Monitor for melanoma- SL exam, A seg photos.
Symptomatic- refer out for laser therapy. May cause scarring. Hyperpigmentation may recur.
Oculodermal Melanocytosis (Nevus of Ota) but only the sclera and urea are involved
Ocular Melanocystosis.
Same risk for glaucoma and transformation into uveal melanoma.
Oculodermal Melanocytosis (Nevus of Ota) but only the sclera is involved
Scleral Melanocystosis.
Typically bilateral, small patches of slate grey pigmentation.
Benign
Common in black and asians
Melanocytic Nevus (mole)
- What is it
- Cause
Benign epidermal/dermal tumor that can occur anywhere on the skin.
Proliferation of melanocytes. Associated with UV exposure.
Junctional- Melanocytes clump at epidermal/dermal junction.
Compound- Melanocytes extend from epidermis to the dermis
Intradermal- Melanocytes clump within dermis. Most common.
Melanocytic Nevus (mole)
Demographics
Laterality
Often appear during puberty
More common in caucasians
Unilateral or bilat
Melanocytic Nevus (mole)
Symptoms
Signs
Asymptomatic, bump on eyelid.
Signs- uniformly pigmented macule (flat lesion), papule, or nodule (dome shape).
Most commonly tan, brown or black. May be amelanotic (pink).
If on the eyelid, likely on the margin.
Melanocytic Nevus (mole) Complications
Malignant potential
Most important sign is documented change but may increase size during puberty
Melanocytic Nevus (mole) Mangagement
Monitor for melanoma- SL exam, A seg pictures.
Surgical excision then biopsy
