Eyelid Malignancy Flashcards
BCC
Develop from a malignancy in the basal layer of the epidermis. Although they can vary in appearance, the classic description if a shiny, firm, pearly nodule with superficial telangiectasia; if not recognized and treated at an early stage, the lesion may progress and develop central ulceration and necrosis (rodent ulcer). BCC is most commonly located on the lower eyelid or the medial canthus
Most common type of skin cancer in the US
BCC
Most common type of eyelid malignancy
BCC
Up to 90% of all cases; it is 40-50x mor ecommon than the 2nd leading eyelid malignancy, SCC. BCCs can be locally invasive, but typically do NOT metastasize (incidence <1%)
SCCs
Malignancy of the stratus spinosum layer of the epidermis. Although they have a variable presentation and may appear simialr to BCCs, SCCs rarely contain superficial telangiectasia. SCC is clinically described as an erythematous plaque that appears rough, scaly, and/or ulcerated; it may be flat or elevated, and is commonly located on the lower eyelid or eyelid margin
SCC metastasis
More aggressive than BCCs. 13-24% undergo metastasis to nearby lymph node
Sebaceous gland carcinomas
Rare with a similar incidence as SCCs. They are malignancies of the sebaceous glands of the eyelids (meibomian or Zeiss). The classic description is a yellow, hard tumor on the upper eyelid that causes madarosis and thickened, red eyelid margins; it is often misdiagnosed in the early stages as recalcitrant unilateral blepharitis or a recurrent chalazion. Sebaceous gland carcinomas are associated with a poor prognosis
- eyelid lesions greater than 2cm are assocaited with a 60% mortality rate
- eyelid lesions that result in symptoms for longer than 6 months are associated with a 38% mortality rate
- overall mortality rate is approximately 10%
Malignant melanomas
Extremely rare (<1% of all eyelid malignancies), but they ar ethe most aggressive and lethal type of eyelid and skin cancer (in particular nodular melanomas). They develop secondary to malignancies of melanocytes within the epidermis. Typically have irregualr borders, uneven pigmentation, and rapid growth
ABCDE of malignancies
Asymmetry Border irregularity Color (uneven pigmentation) Diameter, depth, duration Evolution
Depth and size of the lesion are the two most important prognostic indicators for malignant melanomas
Etiology of BCC
SCC and BCC are both assocaited with chronic UV exposure (esp UV-B)
SCC etiology
Commonly derived from actinic keratosis, a pre malignant (the most common pre cancerous skin lesion), elevated, pink or red scaly lesion that develops on sun exposed skin. 25% of cases of actinic keratosis develop into SCC. Fair skin, prior radiation, burn scars, chemical exposure (chronic smoking), and other forms of chronic irritation are also assocaited risk factors for SCCs
Incidence of actinic keratosis becoming SCC
25%
Sebaceous gland carcinomas etiolgoy
Prior radiation therapy can be assocaited with it
Etiology of malignant melanomas
Commonly arise from dysplasia nevi or tumor metastasis from the lungs or breasts
What does an eyelid malignancy associated with lymphadenopathy mean
Metastasis.
Usually through the preauricular lymph nodes and/or submandibular nodes
Tylosis ciliaris
Thickening of the eyelid margins
