Lumps & Bumps: Vascular Tumors of Eyelid & Conjunctiva

Question 1

vascular tumor caused by disorganized overgrowth of mature capillary tissues due to endothelial cell proliferation

• one of the most common tumors of infancy

Answer 1

capillary hemangioma

Question 2

characteristics:
- strawberry birthmarks in infants
- becomes more elevated for 3-6 mo after dx
- stable by 12-18 mo, then involutes
- usually regresses completely
- main complication: amblyopia & strabismus
- lesion blanches on pressure & can swell when crying

Answer 2

capillary hemangioma

Question 3

management of capillary hemangioma

Answer 3

• careful assessment of VA & refraction
• topical beta-blockers (timolol) - first-line therapy for superficial lesions
• oral propranolol for deeper lesions
• intralesional steroid injection for lesions with amblyogenic potential

Question 4

vascular tumor caused by congenital vascular malformation within superficial dermis

Answer 4

nevus flammeus (port-wine stain)

Question 5

characteristics:

• present at birth & enlarges with time
• upper eyelid involvement
• follows cutaneous distribution of CN V
• sharply demarcated pinkish-purplish patch (doesn’t blanch with pressure)
• most frequently located on face
• associated with soft tissue hypertrophy

Answer 5

nevus flammeus (port-wine stain)

Question 6

when nevus flammeus has upper lid involvement, what is it indicative of

Answer 6

strong indication for glaucoma development

Question 7

nevus flammeus is often associated with what condition

Answer 7

Sturge-Weber syndrome

Question 8

capillary hemangioma & nevus flammeus are ____ vascular tumors of the eyelid

Answer 8

benign

Question 9

what vascular tumor is caused by multiple lesions that usually begin in lower extremeties & spread to other parts of skin & visceral organs

Answer 9

kaposi sarcoma

Question 10

characteristics:

• eyelid lesions PATHOGNOMONIC for AIDS
• present as red, purple, brown, or blue subcutaneous lesions

Answer 10

kaposi sarcoma

Question 11

what treatments are used for karposi sarcoma

Answer 11

chemotherapy for extensive lesions

radiotherapy for small lesions

Question 12

karposi sarcoma is a _____ vascular tumor

Answer 12

malignant

Question 13

what lesion is caused by choristoma (benign tumorous malformation composed of histologically normal tissue at an abnormal location)

Answer 13

conjunctival dermoid

Question 14

characteristics:
- variably sized yellow-white limbal mass (usually inferotemporal)
- lined with squamous epithelium & filled with sweat glands, fat & cilia
- large ones can cause irritation, astigmatism & inadequate eyelid closure

Answer 14

conjunctival dermoid

Question 15

is treatment needed for conjunctival dermoids

Answer 15

surgical removal indicated if dermoid results in amblyopia from astigmatism or dellen formation

Question 16

what conjunctival lesion presents as part of a systemic syndrome

Answer 16

goldenhar syndrome

Question 17

characteristics:
- hypoplasia of malar, maxillary & mandibular regions*
- macrostomia: wide mouth*
- microtia: underdeveloped pinna of the ear
- preauricular & facial skin tags*
- mental handicap
- hemivertebrae (wedge-shaped vertebrae that can result in scoliosis)

Answer 17

goldenhar syndrome

Question 18

what conjunctival lesion is caused by fibrovascular proliferative response to a physical insult

Answer 18

pyogenic granuloma

Question 19

characteristics:
- consists of granulation tissue, proliferation of small blood vessels & inflammatory cells
- a misnomar because lesion is neither pyogenic (pus-producing) nor granulomatous

Answer 19

pyogenic granuloma

Question 20

treatments for pyogenic granuloma

Answer 20

• surgical removal indicated if dermoid results in amblyopia, astigmatism, dellen formation
• topical steroids or excision if steroids don’t work

Question 21

the most common conjunctival melanocytic lesion that is initially noticed in first/second decade of life

Answer 21

conjunctival nevus

Question 22

characteristics:
- solitary lesion, flat/slightly elevated
- mobile over underlying sclera
- plica, fornix & caruncle are uncommon locations
- stable size & pigmentation over time
- frequently contains cystic components

Answer 22

conjunctival nevus

Question 23

what lesion is caused by presence of excess melanin within the basal layer of the conjunctival epithelial melanocytes (melanocyte count is normal)

Answer 23

racial melanosis

Question 24

characteristics:
- bilateral (can be asymmetric) diffuse flat pigmentation of conjunctiva → pigmented epithelium moves freely over the underlying sclera
- appears during first few years of life & becomes static in early adulthood
- may have protective effect against neoplasia
- benign conjunctival epithelial melanosis
- usually concentrated around limbus & perforating branches of vessels or nerves as they enter the sclera
- small cysts can be present with pigmentation

Answer 24

racial melanosis

Question 25

conjunctival dermoid, goldenhar syndrome, pyogenic granuloma, conjunctival nevus & racial melanosis are all what kind of conjunctival lesions

Answer 25

benign conjunctival lesions

Question 26

conjunctival lesion caused by pre-cancerous squamous cell neoplasia of the conjunctival epithelium

Answer 26

intraepithelial neoplasia

Question 27

characteristics:
- usually confined to epithelium, but can progress to invasive SCC
- unilateral in fair-skinned middle-aged & older patients
- fleshly sessile lesion near limbus or interpalpebral fissure

Answer 27

intraepithelial neoplasia

Question 28

conjunctival lesion caused by acquired pigmentation of conjunctiva due to increase in melanocyte numbers in the basal layers of the epithelium

Answer 28

primary acquired melanosis (conjunctival melanocytic intraepithelial neoplasia)

Question 29

characteristics:
- gradual onset in middle-age
- typically unilateral, noncystic patches on the conjunctiva & peripheral cornea
- can be solitary, diffuse, or multifocal

Answer 29

primary acquired melanosis (conjunctival melanocytic intraepithelial neoplasia)

Question 30

management for primary acquired melanosis

Answer 30

long-term f/u

if suspicious → exicion biopsy & mitomycin C

Question 31

intraepithelial neoplasia & primary acquired melanosis are what kind of conjunctival lesions

Answer 31

pre-malignant conjunctival lesions

Question 32

conjunctival lesion that arises from primary acquired melanosis (PAM) in 75% of patients & from pre-existing nevi in 20-25%

Answer 32

malignant melanoma

Question 33

characteristics:

• usually located on bulbar conjunctiva near the limbus
• can recur locally & exhibit regional metastasis to preauricular & submandibular nodes

Answer 33

malignant melanoma

Question 34

conjunctival lesion caused by conjunctival intraepithelial neoplasia (CIN) that has breached basement membrane of the conjunctival epithelium & invaded the underlying tissues

Answer 34

squamous cell carcinoma (SCC)

Question 35

characteristics:
- much less common than CIN but difficult to differentiate from CIN clinically
- large conjunctival feeder vessels usually present
- locally invasive, but only 1-2% metastasize

Answer 35

SCC

Question 36

management of SCC

Answer 36

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

Question 37

conjunctival lesion caused by reactive lymphoid hyperplasia

Answer 37

conjunctival lymphoma

Question 38

characteristics:
- unilateral tumors → 17% chance of systemic lymphoma
- bilateral tuomors → 47% change of systemic lymphoma
- diffuse, slightly elevated, fleshy pink mass
- usually occurs in fornices or bulbar conjunctiva
- symptoms: gradual, painless swelling, redness, irritation

Answer 38

conjunctival lymphoma

Question 39

malignant melanoma, SCC, & conjunctival lymphoma are what type of conjunctival lesions

Answer 39

malignant conjunctival lesions

Question 40

management of conjunctival lymphoma

Answer 40

excision for small lesions

excision + radiotherapy for larger lesions