Derm, Biopsy, Shave Excision

Question 1

Basal cell carcinoma

Answer 1

• Most common malignant tumor of eyelid
• Slow developing, nonresolving lesion
• • Hx of extensive UV exposure
• More common with age, fair-complected patients, with previous Hx skin malignancy

Question 2

Clincal presentation of BCC

Answer 2

• More prevalent on lower lid
• Central, umbilicated ulceration
• Raised, pearly borders
• +/- discharge, crustation, erythema

Question 3

Management of BCC

Answer 3

• Non-responsive to antibiotic/steroid tx suggestive of neoplasia • Metastasis rare
• Slow growing
• Monitor closely
• Photodocument
• Referral for biopsy

Question 4

SCC

Answer 4

• Less common, more aggressive than BCC
• Much higher potential for mets
• ~5-10% of eyelid malignancies, arising de novo or from pre-existing keratosis
• Difficult to distinguish from BCC often, tends to have less surface
vascularization
• Occurs in plaque, nodular, and ulcerating forms
• Conjunctival form as well

Question 5

Hemangioma

Answer 5

• Congenital or appears soon after birth
• Colors vary from faint pink, purple, blue to red
• Typically resolve by adolescence
• Differentiate from other forms of vascular tumors
• Port-Wine stains (nevus flammeus)

Question 6

Hordeolum

Answer 6

Bacterial infection (typically Staph sp.) of multiple glands
• Zeiss/Moll (External) 
• Meibomian (Internal)
Clinical presentation
• Focal tenderness 
• Erythema 
• Pointed lesion (like a pimple)
Management
• Compresses/massage 
• Oral antibiotics 
• Monitor for preseptal cellulitis

Question 7

Seborrheic keratosis

Answer 7

Common
• Some forms regarded as premalignancies
• Slow to change

Clinical characteristics 
• Flat, or elevated plaques
• Circumscribed with distinct borders
• Appear as “stuck on” lesions
• Dry, scaly, feels like sandpaper

Question 8

Molluscum contagiosum

Answer 8

• Most frequent in children

•

Question 9

Clincal characteristics of molluscum contagiosum

Answer 9

•

Question 10

Managment of molluscum

Answer 10

• Dry lesions will resolve

* “Chees

Question 11

Melanocytic nevus

Answer 11

• Typically congenital or early onset
• Junctional, Dermal, and Compound forms
• Usually pigmented
• Well defined borders, presence of hair

Question 12

Papilloma

Answer 12

• Benign, epithelial overgrowths
• Variable presentation in size, shape, and pigmentation
• Typically avascular
• Cosmetic, or functional concerns
• Irritation
• Itching
• Obscures vision

Question 13

Sebaceous cyst

Answer 13

• Vary in size .5mm to 1cm
• Caseous, yellow appearance
• Single or multiple lesions
• Common around lids
• Typically not painful

Question 14

Managment of sebaceous cyst

Answer 14

Incise/evacuate

Question 15

Sudiferous cyst

Answer 15

• Glands of Moll
• Similar to sebaceous cyst but contents are clear

Management
• Lance with needle and drain

Question 16

Verrucae

Answer 16

• AKA verruca vulgaris
• Likely viral, in the wart family
• Single or multiple nonsecreting papillomatous lesions on eyelids

Managment

• monitor
• excision

Question 17

Xanthelasma

Answer 17

• Elderly patients
• Association with hyperlipidemia and hypercholesterolemia
• Flat, triangular masses in the superior and inferior canthal sulci
• May be excised, or smoothed out with RF procedure

Question 18

Dermatoscopy

Answer 18

A noninvasive diagnostic technique for the early
diagnosis of melanoma and the evaluation of other pigmented and
non-pigmented lesions on the skin that are not as well seen with
the unaided eye. Also known as surface microscopy, dermoscopy,
and epiluminescence microscopy.

Originally used oil immersion to visualize skin lesions to assist in
the evaluation of malignancy potential
• Modern devices use polarized light; oil immersion not required

Question 19

Biopsy

Answer 19

Procedure to sample tissue for histopathologic analysis
• Basic types utilized for skin biopsies
• Punch 
• Shave 
• Excisional

Question 20

Most common biopsy for ophthalmic use

Answer 20

Shave