LIDS - MALIGNANT EYELID TUMORS

Question 1

what is the most common malignant eyelid tumor?

Answer 1

basal cell carcinoma (BCC)

Question 2

what is the 2nd most common malignant eyelid tumor?

Answer 2

squamous cell carcinoma (SCC)

Question 3

risk factors for both BCC & SCC?

Answer 3

• elderly
• fair skin (caucasions
• UV exposure

Question 4

what is the location of prevalence for BCC & SCC (in order of most common to least common)

Answer 4

lower lid > medial canthus > upper lid > lateral canthus

Question 5

what are the 3 types of BCC?

Answer 5

• Nodular
• Nodulo-ulcerative
• Morpheaform (sclerosing)

Question 6

signs for nodular BCC

Answer 6

• Shiny firm pearly nodule w/ dilated surface
  vessels (telangiectatic vessels).
• Initially very slow growing
• May develop an ulcer → Nodulo-ulcerative.

Question 7

signs for nodulo-ulcerative (rodent ulcder) BCC

Answer 7

• Increasing radial growth – leads to central ulceration (rodent ulcer).
• Border will be indurated and seem to “roll over.”
• Dilated vessels at margins.

Question 8

signs for sclerosing BCC

Answer 8

• **Indurated plaque **
• Margins difficult to delineate.
• Looks like chronic blepharitis.
• Lateral infiltration beneath the epidermis

Question 9

tx for BCC

Answer 9

• full thickness excision with biopsy
• Rec use of sun protection

Question 10

what is the precursor for SCC?

Answer 10

actinic keratosis

Question 11

how does actinic keratosis appear?

Answer 11

scaly, round erythematous lesion on eyelid

Question 12

what is the most common precancerous skin lesion?

Answer 12

actinic keratosis

Question 13

what lesion can appear similar to SCC?

Answer 13

keratocanthoma

Question 14

how to ddx btwn keratocanthoma and SCC

Answer 14

• Rapid growing lesion (double in size in a few weeks) that is usually found on sun exposed areas and has an appearance like SCC and BCC.
• Spontaneous shrinkage –> complete resolution w/in 1yr.

Question 15

signs of SCC

Answer 15

• Scaly, painless, crusty or ulcerated plaque/nodule
• May be flat or elevated.

Question 16

tx for SCC

Answer 16

• full thickness excision with biopsy
• cryotherapy can be used to tx
• Rec sun protection

Question 17

BCC vs SCC?

Answer 17

• SCC will NOT have a pearly translucent border or telangiectatic vessels

Question 18

what should you suspect if a patient keeps returning with a recurring chalazion in the same location or chronic unilateral blepharitis?

Answer 18

sebaceous cell carcinoma

Question 19

define sebaceous cell carcinoma

Answer 19

• A neoplasm of the sebaceous glands of the eyelids (MG & Zeis).

Question 20

who gets sebaceous cell carcinoma?

Answer 20

M>F who are >50 years or older

Question 21

what factors increase pt’s risk of mortality in sebaceous cell carcinoma?

Answer 21

• If the lid tumor is greater than 2cm.
• If symptoms have been present longer than 6 months
• If there is superior and inferior lid involvment

Question 22

signs of sebaceous cell carcinoma

Answer 22

• Immobile, yellowish (due to presence of lipid) , rock hard tumor (more common on superior lid).
• Madarosis
• Poliosis
• Thickened red lid margin

Question 23

tx for sebaceous cell carcinoma

Answer 23

full thickness excision with biopsy

Question 24

what is the most lethal primary skin tumor?

Answer 24

malignant melanoma but it rare – accounting for 1% of all eyelid tumor

Question 25

tx for malignant melanoma

Answer 25

* full thickness excision with biopsy * orbital exenteration with neck dissection -- in severe cases * Red sun protection * refer to dermatology

Question 26

signs of malignant melanoma?

Answer 26

* A - asymmetric * B - border irregular * C - color uneven * D - diameter large (>6) * E - enlarging & elevated

Question 27

what is kaposi sarcoma? what is it associated with?

Answer 27

* vascular tumors typically associated with **AIDS**!

Question 28

signs of kaposi sarcoma?

Answer 28

* Pink or red to violet lesion * May be found any number of places o Face o Eyelids o Conjunctiva o Mouth

Question 29

list the tumors worse to least bad

Answer 29

melanoma > sebaceous > squamous > basal cell

Question 30

what is capillary hemangioma?

Answer 30

* it is the most common benign orbital tumor in children *

Question 31

signs of capillary hemangioma?

Answer 31

* onset first month of life * superificial vascular lesion (strawberry nevus) with rapid growth. * possible amblyopia -- if they block visual axis or press on the cornea & induce astigmatism

Question 32

tx fro capillary hemangioma?

Answer 32

* spontaneously resolve/disapear by the time patients turns 10