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Ocular Disease part 2 > Lumps and Bumps > Flashcards

Lumps and Bumps Flashcards

1
Q

what is a benign lesion and what are its characteristics?

A

abnormal growth of cells that lack the ability to invade neighboring tissues or metastasize uniform, smooth or papillary and can displace normal structures

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2
Q

what is a malignant lesion and what are its characteristics?

A

cancerous cells that invade and destroy body tissues irregular borders, vascularization/telangiectasia, ulceration and bleeding, alteration or normal architecture, loss of cilia and irregular pigmentary changes

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3
Q

what is a metastatic lesion and what are the characteristics?

A

cancerous cells that spread from a primary site to tissue not directly adjacent to the primary site spread via blood stream or lymph

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4
Q

what is seborrheic keratosis and what causes it?

A

benign pigmented cutaneous lesion - no malignant potential caused by proliferation of basal cells (immature keratinocytes)

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5
Q

who typically gets seborrheic keratosis and how does it present?

A

sun exposure, age, genetics onset in 30’s - more common in patients over 50 present in hair-bearing areas of skin (chest, face, back - not palms or soles)

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6
Q

what are the characteristics of a seborrheic keratosis?

A

usually solitary lesion 1-2cm, moveable hyperpigmented plaque, elevated with waxy surface and sharp demarcation

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7
Q

what is the treatment for a seborrheic keratosis?

A

obervation and cryotherapy, laser therapy or excision if they bother the patient

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8
Q

what syndrome is associated with seborrheic keratosis?

A

leser-trelat syndrome = sudden onset of multiple SK’s - usually onset of internal malignancy (stomach, liver, colon, pancreas cancers)

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9
Q

what is squamous papilloma?

A

benign hyperplasia of squamous epithelium flesh colored with cerebriform surface (pedunculated or sessile)

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10
Q

who typically presents with squamous papilloma?

A

middle-aged and elderly patients (gradual onset and slow growth)

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11
Q

what are some differential diagnoses for squamous papilloma?

A

basal cell carcinoma, seborrheic keratosis, and verruca vulgaris (* all benign tumors of the epidermis)

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12
Q

what is verruca vulgaris?

A

squamous papilloma caused by the human papilloma virus - can have concomitant conjunctivitis multiple lesions

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13
Q

who typically gets verruca vulgaris?

A

immunocompromised patients, children and young adults

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14
Q

what is the treatment for verruca vulgaris?

A

observation, complete surgical excision or cryotherapy - usually spontaneous resolution

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15
Q

what is molluscum contagiosum?

A

viral infection of the skin - multiple pearly flesh colored lesions with a small central crater

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16
Q

who typically gets molluscum contagiosum?

A

common in children suspect immunocompromised state if present in adults or severe bilateral involvement in children

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17
Q

what is the transmission of molluscum contagiosum?

A

pediatric = direct contact adult = STD

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18
Q

what is the treatment for molluscum contagiosum?

A

incision and expression, cryotherapy, excision or laser treatment - recurrence is rare after complete resolution

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19
Q

what condition is molluscum contagiosum associated with?

A

chronic follicular conjunctivitis

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20
Q

what is keratoacanthoma?

A

a pre-malignant tumor of the epidermis, develops on hair-bearing sun exposed skin (85% on face and 5% on eyelids)

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21
Q

who typically gets keratoacanthoma?

A

males > females and greater prevalence in immunosuppressed patients (s/p renal transplantations)

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22
Q

what are the characteristics of keratoacanthoma?

A

elevated margins with central crater, usually solitary lesion, rapid onset/growth, spontaneous regression

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23
Q

what is the histopathology for keratoacanthoma?

A

well differentiated squamous cells with keratin-containing center

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24
Q

what are some risk factors for keratoacanthoma?

A

skin color, UV radiation, trauma and genetics - may be a clinical variant of squamous cell carcinoma

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25
Q

what is the treatment for keratoacanthoma?

A

observation and complete removal via surgical excision

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26
Q

what is actinic keratosis?

A

most common pre-cancerous cutaneous lesion - caused by proliferation of atypical keratinocytes

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27
Q

who typically gets actinic keratosis?

A

light-skinned, F > M, mean age is 62, UV exposed skin

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28
Q

where is actinic keratosis usually located?

A

face, eyelids, dorsa of hands and bald areas on men

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29
Q

what can actinic keratosis progress to if untreated?

A

20% progression to squamous cell carcinoma

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30
Q

what does actinic keratosis look like?

A

multiple, erythrmatous, sessile plaques, 1-10mm, pink in color but can be pigmented, less distinct margins than seborrheic keratosis

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31
Q

when do you biopsy a actinic keratosis lesion?

A

when lesions appear indurated, painful, ulcerated, bleeding or hyperkeratotic lesions unresponsive to standard therapy

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32
Q

what are some treatment options for actinic keratosis?

A

destructive therapy - single lesions (cryotherapy, shave excision or surgical excision), topical medications - multiple lesions, photodynamic therapy and chemical peels

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33
Q

what is squamous cell carcinoma?

A

2nd most common eyelid malignancy (after basal cell carcinoma)

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34
Q

who typically gets squamous cell carcinoma?

A

fair-skin, 50-80 y/o, M > F, chronic UV exposure, many x-rays, severe sunburns

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35
Q

what are the 2 types of squamous cell carcinoma?

A

bowen’s disease and invasive SCC

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36
Q

what does squamous cell carcinoma look like?

A

broad spectrum of appearances: small red scaly patches, large ulcerated lesions, small nodular lesions, occurs more on upper eyelid, can be irritating or bleed

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37
Q

what is the course of squamous cell carcinoma?

A

aggressive = fast growing, 2-5% metastasize and more likely to recur

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38
Q

what is the treatment for squamous cell carcinoma?

A

mohs microsurgery or frozen section - radiotherapy, cryotherapy, intralesional chemotherapy and photodynamic therapy

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39
Q

what is basal cell carcinoma?

A

most common malignant tumor of the skin (90% of eyelid tumors)

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40
Q

what are the risk factors for basal cell carcinoma?

A

older age, light skin, sunlight exposure, prior irradiation, and immunosuppression F > M and 50-80 y/o

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41
Q

where are basal cell carcinoma’s usually located? what do they look like?

A

lower eyelid, head/neck region pearly, waxy, rolled, telangiectatic borders with central ulceration

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42
Q

what are the treatments for basal cell carcinoma?

A

small lesions = resection large lesions = mohs chemotherapy

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43
Q

what is the prognosis for basal cell carcinoma?

A

rarely metastasize, low mortality (intracranial invasion), locally invasive and destructive if left untreated

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44
Q

what is a melanocytic nevus?

A

darkly pigmented lesion containing modified melanocytes, may contain hair

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45
Q

how do you get a melanocytic nevus?

A

acquired or congenital (acquired - 5-15 y/o) and if multiple lesions = dysplastic nevus syndrome

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46
Q

what is oculodermal melanocytosis (nevus of ota)?

A

congenital pigmentation of periocular skin, uveal tract, sclera or ipsilateral meninges

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47
Q

who typically gets oculodermal melanocytosis?

A

rare in Caucasians - more common in Asian and African Americans

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48
Q

what does oculodermal melanocytosis look like?

A

flat lesion, tan-gray, follows V1 and V2 of CNV (bilateral in 10% of cases)

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49
Q

what is the treatment for oculodermal melanocytosis?

A

periodic DFE to r/o uveal melanoma

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50
Q

what is lentigo maligna (melanotic freckle of hutchinson)?

A

an acquired cutaneous pigmentation on exposed skin areas

51
Q

who typically gets lentigo maligna?

A

middle-aged, elderly Caucasians

52
Q

what does lentigo maligna look like?

A

flat, well-circumscribed, irregular, tan-brown macule, grows slowly

53
Q

what are some differential diagnoses for lentigo maligna?

A

seborrheic keratosis, acquired melanocytic nevus, malignant melanoma

54
Q

what is lentigo maligna associated with and what is the treatment?

A

primary acquired melanosis of conjunctiva wide surgical resection

55
Q

what is primary malignant melanoma?

A

due to sun exposure in Caucasians, due to proliferation of atypical melanocytes, occurs mostly on lower eyelid (worse prognosis)

56
Q

what are the clinical features of a primary malignant melanoma?

A

can extend into orbit via neural invasion, can metastasize after many years, advanced have ulcerative and nodular presentations

57
Q

what is the management and prognosis for primary malignant melanoma?

A

management = surgical excision and eyelid reconstruction prognosis = nodular has worst, then thicker lesions then thin lesions

58
Q

what can you use for early detection of melanomas?

A

A = asymmetry B = borders C = color D = diameter

59
Q

how far into the skin do actinic keratosis, squamous cell carcinoma, basal cell carcinoma and melanomas go?

A

actinic keratosis = epidermis squamous cell carcinoma = dermis (though basal cell layer) basal cell carcinoma = dermis melanoma = all layers (through dermis)

60
Q

what is sebaceous gland carcinoma?

A

solitary nodule or diffuse eyelid thickening origins = meibomian glands of upper tarsus, glands of zeis and caruncle

61
Q

who typically gets sebaceous cell carcinoma?

A

2-7% of malignant eye tumors, most common in 5-7th decades and 70% female

62
Q

what is the prognosis of sebaceous gland carcinoma?

A

83% mortality if upper and lower eyelids are involved

63
Q

what are the clinical features of a sebaceous gland carcinoma?

A

aggressive local behavior, metastasizes to retinal lymph nodes and distant organs, masquerades as other benign lesions resulting in delay in diagnosis and treatment cardinal signs = madarosis, poliosis, thickening of lid margin more common in upper eyelid

64
Q

what is an eyelid xanthelasma?

A

benign aggregation of lipid filled macrophages within the dermis - usually bilateral

65
Q

what does an eyelid xanthelasma look like?

A

bilateral, single/multiple flat, yellow placoid lesion lesion that affects loose aspects of eyelids

66
Q

what is a sebaceous cyst?

A

benign - due to occlusion of a sebaceous gland duct (most commonly in meibomian glands of upper tarsus) common on scalp and eyebrow

67
Q

what is the treatment for a sebaceous cyst?

A

hot compresses

68
Q

what is an eccrine hidrocystoma?

A

benign - ductal retention cyst of sweat glands (heat, humidity, perspiration can cause an enlargement)

69
Q

what does an eccrine hidrocystoma look like and what is the treatment?

A

clear cystic translucent lesion near eyelid margin observation or excision

70
Q

what is an apocrine hidrocystoma?

A

benign - retention cyst of apocrine gland (moll), usually solitary, common near medial canthus, bluish in color

71
Q

what is an eyelid syringoma?

A

benign - sweat gland cyst, solitary or multiple, more pronounced on lower eyelid, very small

72
Q

who typically gets eyelid syringoma?

A

young adult women, Asian patients

73
Q

what is eyelid sweat gland carcinoma?

A

malignant - very uncommon tumors arise from epidermal cells of sweat glands of Moll, common in lower eyelid

74
Q

who typically gets eyelid sweat gland carcinoma?

A

mean age = 63, 2:1 male to female ratio

75
Q

what does an eyelid sweat gland carcinoma look like?

A

high content of mucin, slow growth, pink-blue elevated nodule, solid or cystic and near eyelid margin

76
Q

what is a capillary hemangioma?

A

benign - strawberry birthmarks in infants (grows during first few months of life) one of the most common tumors in infancy

77
Q

what is the pathology of capillary hemangioma?

A

proliferating benign endothelial cells and numerous small vascular channels

78
Q

what are some complications of capillary hemangioma’s and what is the treatment?

A

amblyopia and strabismus topical beta blockers (timolol) - superficial lesions oral propanolol - deeper lesions intralesional steroid injection for lesions with amblyopgenic potential

79
Q

what is an acquired hemangioma?

A

benign - common on trunk and extremities, moveable with skin, may bleed with trauma and common in elderly patients

80
Q

what is a nevus flammeus?

A

benign - port wine hemangioma corresponds with cutaneous distribution of CN V present at birth and enlarges with time

81
Q

what can occur if the upper lid is involved in a nevus flammeus?

A

a strong indicator for glaucoma development

82
Q

what is the treatment for nevus flammeus?

A

laser photocoagulation

83
Q

what is an eyelid lymphangioma?

A

benign - growth of lymph channels - can occur in various parts of the body occurs deep to dermis as dark blue and soft mass (can slowly enlarge)

84
Q

what is an eyelid kaposi’s sarcoma?

A

malignant - multiple lesions usually benign in lower extremities and spreads to other parts of the skin and visceral organs

85
Q

what does an eyelid kaposi’s sarcoma look like?

A

red, purple, brown, or blue, flat subcutaneous lesion can be diffuse, nodular or pedunculated initially has a smooth surface that becomes rough and crusty

86
Q

who typically gets an eyelid kaposi’s sarcoma?

A

AIDS patients, immunosuppressed adults after renal transplantation

87
Q

what is the treatment for eyelid kaposi’s sarcoma?

A

chemotherapy for extensive lesions, radiotherapy for small local lesions

88
Q

what is an eyelid lymphoma?

A

can be benign, intermediate or malignant types = hodgkin’s vs. non-hodgkins and B-cell or T-cell

89
Q

who typically gets eyelid lymphoma’s?

A

usually affects the elderly - suspect immunocompromised if younger patients (AIDS)

90
Q

what is a metastatic neoplasm?

A

metastatic cancer of the eyelids - very uncommon usually solitary subcutaneous nodule resembling a chalazion

91
Q

what is lymphangiectasia?

A

benign - dilation of lymphatic channels within conjunctiva bleeding can occur, solitary or multifocal, typically unilateral and sporadic

92
Q

what is a conjunctival dermoid?

A

benign - tumorous malformation composed of tissue not typically present at involved site variably sized yellow-white limbal mass (usually infrotemporal)

93
Q

what are the symptoms for a conjunctival dermoid?

A

small = asymptomatic large = irritation, astigmatism and inadequate eyelid closure

94
Q

what is the treatment for a conjunctival dermoid?

A

surgical removal if causing amblyopia, astigmatism, dellen formation

95
Q

what is a conjunctival dermolipoma?

A

benign - less well defined than a dermoid and usually located superotemporally yellow sessile lesion may contain bone, cartilage, and ectopic lacrimal gland

96
Q

when does a conjunctival dermolipoma usually appear and what is the treatment?

A

1st or 2nd decade typically non-progressive and doesn’t require treatment

97
Q

what is a conjunctival papilloma seen in childhood?

A

benign - virus induced (HPV types 6 or 11) usually larger and multiple, fleshy red appearance due to multiple vascular channels inferior fornix or bulbar conjunctiva

98
Q

what is a conjunctival papilloma seen in adults?

A

benign - HPV type 7, unilateral and solitary, begins at limbus or bulbar conjunctiva, lighter pink color, low malignancy

99
Q

what is racial melanosis?

A

benign - complexion related pigmentation, bilateral diffuse flat pigmentation of conjunctiva, most concentrated at limbus

100
Q

what causes racial melanosis?

A

hyperpigmentation of basal cells of the conjunctival epithelium

101
Q

what is primary acquired melanosis?

A

due to increase in melanocytes in basal layers of epithelium

102
Q

what does primary acquired melanosis look like?

A

gradual onset in middle age typically unilateral, non-cystic patches on conjunctiva and peripheral cornea

103
Q

what is the treatment for primary acquired melanosis?

A

biopsy and if suspicious - excision and mitomycin C

104
Q

what is intraepithelial neoplasia?

A

benign squamous cell neoplasia of the surface epithelium - doesn’t metastasize but is pre-cancerous

105
Q

what does intraepithelial neoplasia look like?

A

unilateral, fleshy, sessile lesion near limbus or interpalpebral fissue (can extend into corneal epithelium)

106
Q

who typically gets an interepithelial neoplasia?

A

predisposing factors = sunlight or HPV immunosuppressed patients, middle-age/elderly

107
Q

what is a squamous cell carcinoma?

A

CIN that has breached basement membrane of the epithelium and invaded underlying stroma wide variety of appearances = gelatinous, sessile, papillomatous large conjunctival feeder vessels are usually present

108
Q

what is the management for squamous cell carcinoma?

A

complete surgical excision - topical mitomycin-C, 5-fluorouracil, cidofovir

109
Q

what is conjunctival lymphoma?

A

malignant - diffuse, slightly elevated, redish/pink mass

110
Q

where do conjunctival lymphomas usually present?

A

fornices or bulbar conjunctiva unilateral or bilateral

111
Q

what is the treatment for conjunctival lymphoma’s?

A

excision of small lesions excision and chemotherapy for larger lesions

112
Q

what is a malignant melanoma?

A

pigmented, fleshy, elevated, poorly defined conjunctival lesion, usually located on bulbar conjunctiva near limbus

113
Q

who typically gets a malignant melanoma?

A

light skin, middle age/elderly, M = F

114
Q

what is the management and mortality rate for malignant melanomas?

A

excision and mortality rate of 25%

115
Q

what is an iris cyst?

A

benign - arise from iris pigment epithelium and located in inferotemporal quadrant

116
Q

what can an iris cyst cause?

A

typically asymptomatic - can cause elevated IOP due to angle obstruction

117
Q

what is an iris melanoma?

A

pigmented or amelanotic, elevated with feeder vessels and usually there is a history of a nevus undergoing growth

118
Q

what is orbital fat prolapse?

A

benign - protrusion of orbital fat through defect in Tenon’s capsule into conjunctival fornix soft yellow mass in superotemporal conjunctival fornix

119
Q

who typically gets orbital fat prolapse?

A

very common in older patients and obese male patients

120
Q

what are some differential diagnoses for orbital fat prolapse?

A

dermolipoma, lymphoma, and lacrimal gland tumor

121
Q

what is a dermoid cyst?

A

benign - congenital cystic lesion most common cystic lesion of the orbit

122
Q

what causes a dermoid cyst?

A

entrapped ectoderm at site of embryologic bony future

123
Q

what does a dermoid cyst look like?

A

firm subcutaneous mass, non-movable as attached to bone, filled with hair, sebaceous glands and sweat glands

Ocular Disease part 2 (7 decks)

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