Eyelids Flashcards
Syringomas are?
benign proliferations arising from eccrine sweat
glands.
Syringomas are characterized by_______ that are often _______ and _______.
small papules that are often
multiple and bilateral.
_____ is the most common hair follicle proliferation seen by ophthalmologists.
Pilomatricoma
Two other names for Pilomatricoma
Pilomatrixoma, calcifying epithelioma of Malherbe
Pilomatricoma is derived from _______.
the germinal matrix cells of the hair bulb
Pilomatricoma affects ______ (2)_______ and is more common
in ______.
children and young adults and is more common
in females.
Pilomatricoma: Clinically it appears as a ________
mobile purplish dermal nodule that may have a hard consistency
due to calcification
Pilomatricoma: Malignant change is ______. The lesion is usually ________.
rare, removed surgically.
Other less common disorders of hair follicle proliferation include____(3)_____.
trichofolliculoma, trichoepithelioma, and trichilemmoma.
Capillary haemangioma (strawberry naevus) is one of the most
common tumors in _____. It is three times as common in _______.
infancy, girls
Capillary haemangioma: It presents shortly after birth as a unilateral, raised bright
red lesion (Fig. 2.13B), usually in the upper lid.
Capillary haemangioma: A deeper lesion appears______.
purplish.
Capillary haemangioma: The lesion blanches on pressure and may swell on crying.
Capillary haemangioma: Ptosis is frequent and there may be orbital extension
Capillary haemangioma: Occasionally the lesion may involve the skin of the face and some patients have strawberry naevi on other parts of the body.
It is important to be aware of an association between multiple cutaneous lesions and visceral haemangiomas and to consider systemic assessment in appropriate cases.
A capillary haemangioma can be easily and successfully treated by regular application of a topical beta-blocker to the affected lesion.
Port-wine stain (naevus flammeus) is a congenital malformation of
vessels within the superficial dermis
Port-wine stain: consisting histopathologically
of vascular spaces of varying calibre separated by thin fibrous septa
Port-wine stain: About 10% have associated ocular or CNS involvement,
including Sturge–Weber (see below) and other defined
syndromes.
Port-wine stain manifests clinically as a sharply demarcated soft
pink patch that does not blanch with pressure, most frequently
located on the face.
It is usually unilateral and tends to be aligned
with the skin area supplied by one or more divisions of the
trigeminal nerve
Darkening to red or purple
takes place with age and there is commonly associated soft tissue
hypertrophy (Figs 2.14D–F). Bleeding may occur from focal overlying
lobulations (pyogenic granulomas – see below).
Treatment with laser (e.g. pulsed-dye) is effective in decreasing
skin discoloration, particularly if undertaken early. Topical
preparations such as imiquimod and rapamycin, alone or with
adjuvant laser, show promise. Soft tissue debulking is used in a
small number of cases. Screening for glaucoma should begin in
infancy. Systemic investigation is considered in some patients,
particularly those with a lesion of the lumbar area.
Sturge–Weber syndrome (encephalotrigeminal angiomatosis) is a
congenital, sporadic phacomatosis.
Sturge–Weber syndrome: consists of ____(3)_____
Port-wine stain, Leptomeningeal haemangioma, Ocular features.
Sturge–Weber syndrome: Port-wine stain, extending over the area corresponding to the
distribution of one or more branches of the trigeminal nerve.
Sturge–Weber syndrome: Leptomeningeal haemangioma involving the ipsilateral
parietal or occipital region may cause contralateral focal or
generalized seizures, hemiparesis or hemianopia.
Sturge–Weber syndrome: Ocular features may include ipsilateral glaucoma, episcleral
haemangioma, iris heterochromia and diffuse choroidal
haemangioma (see Ch. 20).
Pyogenic granuloma is a rapidly growing vascularized proliferation
of granulation tissue
Pyogenic granuloma is usually antedated by surgery,
trauma or infection, although some cases are idiopathic
Pyogenic granuloma: Clinically there is a painful, rapidly growing, vascular granulating polypoidal
lesion (Fig. 2.15) that may bleed following relatively trivial trauma.
Cutaneous lesions should be excised.
Cutaneous neurofibromas are_______
benign nerve tumours, usually
nodular or pedunculated, that can be found anywhere on the
skin.
Plexiform neurofibromas typically
present in childhood as a manifestation of neurofibromatosis
type 1 with a characteristic S-shaped deformity of the upper
eyelid
Cutaneous neurofibromas: Treatment of solitary lesions involves simple excision, but removal of the more diffuse plexiform lesions may be
difficult.
Rare predisposing conditions of eyelid malignancies are ____(6)____
Xeroderma pigmentosum, Gorlin–Goltz syndrome, Muir–Torre syndrome, Bazex syndrome, immunosuppression, prior retinoblastoma, and albinism.
Xeroderma pigmentosum is characterized by_________.
skin damage on exposure to sunlight, leading to progressive cutaneous abnormalities
Xeroderma pigmentosum: More than 90% have ocular or periocular involvement and 65% experience photophobia.
Xeroderma pigmentosum: Affected patients have a bird-like facial appearance and a significant propensity to the development of basal cell carcinoma (BCC), squamous cell carcinoma (SCC) and melanoma
Xeroderma pigmentosum: It is inherited in an autosomal recessive (AR) fashion.
Gorlin–Goltz syndrome (naevoid BCC syndrome) is a rare disorder characterized by _______ (Fig. 2.17B) and
by extensive congenital deformities of the eye, face, bone, and central nervous system.
Gorlin–Goltz syndrome (naevoid BCC syndrome): It is inherited in an______
autosomal dominant (AD)
Gorlin-–Goltz syndrome (naevoid BCC syndrome): Many patients develop multiple small BCC during the second decade of life.
Gorlin–Goltz syndrome (naevoid BCC syndrome): Patients are also predisposed
to medulloblastoma, breast carcinoma, and Hodgkin lymphoma.
Muir–Torre syndrome is a rare AD condition that predisposes to ____(2)____
cutaneous and internal malignancies.
Muir–Torre syndrome: Cutaneous tumours include BCC, sebaceous gland carcinoma and keratoacanthoma.
Muir–Torre syndrome: Colorectal and genitourinary carcinomas are the most common systemic tumors.
Muir–Torre syndrome: It is inherited in an______
AD fashion
Bazex syndrome can be used to describe two distinct conditions:
Bazex–Dupré–Christol syndrome, acrokeratosis paraneoplastica of Bazex
Acrokeratosis paraneoplastica of Bazex, in which ____________ lesions are associated with an
underlying malignancy of________
eczema-like and psoriatiform, the upper respiratory or digestive tract.
Bazex–Dupré–Christol syndrome: a condition characterized by multiple BCCs, commonly
facial including the eyelids
Bazex–Dupré–Christol syndrome: associated with skin changes
including follicular indentations without hairs on extensor
surfaces (follicular atrophoderma), hypohidrosis and hypotrichosis.
Bazex–Dupré–Christol syndrome: It is inherited in an______
X-linked dominant fashion
BCC is the most common human malignancy and typically affects
older individuals.
Ninety per cent
of cases occur in the head and neck and about 10% of these involve
the eyelid.
BCC is by far the most common malignant eyelid
tumour, accounting for 90% of all cases.
It most frequently arises
from the lower eyelid, followed in relative frequency by the medial
canthus, upper eyelid and lateral canthus.
Tumours
located near the medial canthus are more prone to invade the
orbit and sinuses, are more difficult to manage than those arising
elsewhere and carry the greatest risk of recurrence.
Tumours
that recur following incomplete treatment tend to be more
aggressive.
Eyelid BCC conforms to one of the morphological patterns:
Nodular BCC, Nodulo-ulcerative BCC (rodent ulcer), Sclerosing (morphoeic) BCC, Other types.
Nodular BCC is a shiny, firm, pearly nodule with small
overlying dilated blood vessels. Initially, growth is slow and it
may take the tumour 1–2 years to reach a diameter of 0.5 cm
Nodulo-ulcerative BCC (rodent ulcer) is centrally ulcerated
with pearly raised rolled edges and dilated and irregular
blood vessels (telangiectasis) over its lateral margins (Fig.
2.19C). With time it may erode a large portion of the eyelid
Sclerosing (morphoeic) BCC is less common and may be
difficult to diagnose because it___________.
infiltrates laterally beneath the epidermis as an indurated plaque.
The lesion tends to be much more extensive on palpation than inspection.
Other types not usually found on the lid are cystic, adenoid,
pigmented and multiple superficial.
Sclerosing BCC can mimic a localized area of unilateral
chronic blepharitis.
sclerosing BCC may simulate a localized area of chronic blepharitis.
SCC metastasis to regional lymph nodes in about 20%
of cases
Careful surveillance of
regional lymph nodes is therefore an important aspect of initial
management.
SCC The tumour may also exhibit perineural spread to
the intracranial cavity via the orbit.
SCC accounts for 5–10% of
eyelid malignancies and may arise de novo or from pre-existing
actinic keratosis or carcinoma in situ (Bowen disease, intraepidermal
carcinoma
Immunocompromised individuals,
such as those with acquired immunodeficiency syndrome (AIDS)
or following renal transplantation are at increased risk, as are those
with a predisposing syndrome such as xeroderma pigmentosum.
The tumour has a predilection for the lower eyelid and the lid
margin. It occurs most commonly in older individuals with a fair
complexion and a history of chronic sun exposure.
Ostensibly benign lesions such as keratoacanthoma and
cutaneous horn may reveal histological evidence of SCC in
deeper levels of sectioning.
Keratoacanthoma is a __________
rare, rapidly growing but subsequently regressing tumour
Keratoacanthoma usually occurs in ____(2)____.
_______ is also a predisposing factor.
usually occurs in fair-skinned individuals with a history of chronic sun exposure. Immunosuppressive
therapy is also a predisposing factor.
Keratoacanthoma Invasion and metastasis are ______.
rare.
Keratoacanthoma: A sharp transition from the thickened involved area to normal adjacent epidermis is referred to as ______, and a __________ may be seen.
shoulder formation and a keratin-filled crater may be seen.
Keratoacanthoma appearance: (Fig. 2.22D). Complete involution may take up to a year
and usually leaves an unsightly scar.
A pink dome-shaped hyperkeratotic lesion develops
Keratoacanthoma location:
often on
the lower lid
Keratoacanthoma timeline:
may double or treble in size within weeks. Growth then ceases for 2–3 months, after which
spontaneous involution occurs, when a keratin-filled crater may develop.
Keratoacanthoma - Complete involution may take up to ______
and usually leaves an unsightly scar.
a year
Sebaceous gland carcinoma (SGC) is a very rare, slowly growing
tumour that most frequently affects the _____, with a predisposition
for _____.
elderly, with a predisposition
for females
SGC usually arises from the _______,
although on occasion it may arise from the ________.
meibomian glands, glands of Zeis or
elsewhere.
SGC - Pagetoid spread refers to _______ and is not uncommon.
extension
of a tumour within the epithelium
SCG Overall mortality is _____
5–10%.
SCG Adverse prognostic features include
upper lid involvement, tumour size of 10 mm or more and duration of
symptoms of more than 6 months.
In contrast to BCC and SCC, SGC occurs more commonly on _________.
the
upper eyelid where meibomian glands are more numerous.
SGC - There may be simultaneous involvement of __________.
the lower and upper lid on one side (5%).
Yellowish material within a tumor is highly suggestive of ______.
SGC.
Nodular SGC presents as a _________________, most commonly
within the ____________.
as a discrete, hard nodule, most commonly within the upper tarsal plate
Nodular SGC may exhibit yellow discoloration due to the presence of ______.
lipid.
Nodular SGC may be mistaken for a
chalazion.
Spreading SGC infiltrates into the______ and causes a _________ often with _______ and can be mistaken for blepharitis.
dermis, diffuse thickening of the lid margin, eyelash distortion and loss
SGC can be confused with
chronic or recurrent localized meibomian gland inflammation.
Clinically lentigo maligna presents as a _____________
slowly expanding pigmented macule with an irregular border.
Lentigo maligna: Treatment is usually by_________.
excision.
Lentigo maligna: _____(2)____are highly suggestive of malignant transformation.
Nodular thickening and areas of irregular pigmentation
Lentigo maligna (melanoma in situ, intraepidermal melanoma, Hutchinson freckle) is an uncommon condition that develops in____(2)____.
sun-damaged skin in elderly individuals.
Superficial spreading melanoma is characterized
by a plaque with an irregular outline and variable pigmentation
Nodular melanoma is typically a _____ surrounded by normal skin
blue-black nodule
Melanoma: Treatment is usually by _____and may include ______.
wide excision, local lymph node removal.
Melanoma: Early detection carries a good prognosis and _______ is often curative
surgical excision
Melanoma: ________ are of limited efficacy, but new approaches using ______ are
showing considerable promise.
Radiotherapy and chemotherapy, immunotherapy
Merkel cells are a form of sensory receptor concerned with ______.
light touch.
Merkel cell carcinoma is a _____ tumour that typically affects ______.
rapidly growing, highly malignant, older adults.
Merkel cell carcinoma: ____% of patients have metastatic spread by presentation.
50%
Merkel cell carcinoma: most frequently involving the _______.
upper eyelid
Merkel cell carcinoma: Treatment is by _________.
excision, often with adjuvant therapy.
Kaposi sarcoma is a ________ that typically affects individuals with AIDS.
vascular tumor
Kaposi sarcoma: presents clinically as_______, which may be mistaken for a haematoma or naevus.
a pink, red-violet to brown lesion
Kaposi sarcoma: Treatment is by ____(3)____
radiotherapy or excision and by optimal control of AIDS.
Kaposi sarcoma: may be mistaken for ____(2)____.
haematoma or naevus.
