MALIGNANT Eyelid Lumps & Bumps Flashcards
1
Q
Describe Basal Cell Carcinoma (BCC)?
A
- Commonest malignant tumour of the eyelids
- 90% of all eyelid malignant tumours
- Lower eyelid & medial canthus most commonly involved but can happen anywhere on eyelid
- Can also happen on scalp, neck, face – all exposed areas to sunlight
- Chronic sun exposure – ultraviolet light
- Caucasians, usually >50
- Seen v commonly in Australia & New Zealand
- AIDS patients at risk of multiple BCCs – as low immunity
- Typical appearance – nodular lesion w/ pearly shiny white edges, central ulceration
- Painless, slowly growing
- Spreads locally – does not spread to other parts of the body
- Reassure patients that although it is a cancer – once it is removed it results in a complete cure
- Morphoeic BCC – indistinct, spread under the skin – can become quite extensive locally
- Typical things that could raise the suspicion of a malignant tumour are changes to overlying skin scarring, loss of eyelashes should alert to the possibility, loss of normal skin hair
2
Q
What is the management of Basal Cell Carcinoma (BCC)?
A
- Biopsy to prove diagnosis
- Surgical excision – once diagnosis confirmed – as long as surgery removes whole of the lesion then it is completely cured
- Mohs micrographic surgery – when lesion edges are not well defined
- Cryotherapy – freeze therapy like for warts – used in pxs who have v extensive disease or who are unfit for undergoing surgery
- Radiotherapy – used in pxs who have v extensive disease or who are unfit for undergoing surgery
3
Q
Describe Squamous Cell Carcinoma?
A
- Second most common eyelid malignancy
- Typically >70 years
- Fair skinned patients w/ history of chronic skin exposure are more commonly affected
- Patients w/ lymphoma, leukaemia, HIV, organ transplant pxs on immunosuppression more at risk
- Typically occurs at eyelid margin
- Loss of eyelashes shows signs of malignancy
- Not as well defined as BCC
- Painless slightly raised plaque or nodule with central ulceration, crusting or scaling
- More aggressive than BCC & enlarges more rapidly and can spread to sinuses and orbit
- Distant metastasis can occur
- Hard to tell difference between the carcinomas but if refer urgently as you suspect it is malignant then have done job properly
4
Q
What is the management of Squamous Cell Carcinoma?
A
- If no distant spread – surgical excision with frozen section control and wide excision margins, prognosis v good if has not spread
- If distant spread – palliative, risk of death over period of 5 year is significant
5
Q
Describe Sebaceous Cell/Gland Carcinoma?
A
- Third most common eyelid malignancy
- Arises from meibomian glands of tarsal plate & sebaceous glands of eyelids, eyebrow & caruncle (small, pink, globular spot at inner corner/medial canthus)
- Typically affects eyelid margins w/ gradual thickening & loss of eyelashes
- Can present as persistent blepharitis, recurrent chalazia in early stages
- Pxs who present with unilateral blepharitis should raise your suspicions of this being cancerous – bleph is usually symmetrical & bilateral
- Aggressive tumour
- Distant metastasis common
- Surgical treatment involves excision of tumour w/ frozen section control & reconstruction
- Recurrences in up to 36% pxs after excision
- 10-year mortality 28%
6
Q
Describe Eyelid Malignant Melanoma?
A
- 1% of eyelid malignant tumours
- Most aggressive
- Pigmented tumours – irregular and variable pigmentation & distortion of surrounding architecture
o Compared to nevus which is quite uniformly pigmented - Distant spread common – often resulting in death over time
- Treatment – wide surgical excision & management metastases
7
Q
What is one of the important signs of a malignant eyelid lesion?
A
Loss of eyelashes in lid margin lesions
Also:
-Margins often indistinct (except in nodular BCC)
-Gradual destruction of overlying skin architecture
-Surface ulceration & crusting & bleeding of skin is common
8
Q
What do you do if you see a malignant tumour?
A
URGENTLY refer to hospital to confirm diagnosis & treat appropriately
