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Ocular Disease > Midterm 2- Lid bumps > Flashcards

Midterm 2- Lid bumps Flashcards

1
Q

Macule:

A

Circumscribed, flat discoloration , <1cm

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2
Q

Patch:

A

Circumscribed, flat discoloration , >1cm

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3
Q

Papule:

A

Circumscribed, elevated superficial solid lesions, < 1cm

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4
Q

Plaque:

A

Circumscribed, elevated superficial solid lesions, > 1cm

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5
Q

Nodule:

A

Solid lesions with depth above, level or below surface, < 1cm

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6
Q

Tumor:

A

Solid lesions with depth, above, level or below surface, > 1cm

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7
Q

Vesicle:

A

Circumscribed elevations containing serous fluid, < 1cm

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8
Q

Bulla:

A

Circumscribed elevations containing serous fluid, > 1cm

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9
Q

Petechia:

A

Petechia: Circumscribed deposits of blood or blood products, < 1cm

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10
Q

Purpura:

A

Circumscribed deposits of blood or blood products, < 1cm

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11
Q

Sessile:

A

A lesion fixed to the skin on a broad base

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12
Q

Pedunculated:

A

A lesion on a stalk

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13
Q

Papillomatous:

A

A lesion exhibiting a surface resembling a cauliflower or artichoke

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14
Q

Scales:

A

Shedding, dead epidermal cells, dry or greasy

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15
Q

Umbilicated:

A

The lesion exhibits a central crater like an umbilicus or belly button

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16
Q

Crusts:

A

Dried masses of skin exudates

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17
Q

Ulcer:

A

Irregularly sized and shaped excavations extending into the dermis

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18
Q

Hyperplasia

A

Increase in number of cells

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19
Q

Metaplasia

A

Change in type of adult cells which is abnormal for that tissue

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20
Q

Dysplasia

A

Alteration in size, shape, organization of adult cells

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21
Q

Neoplasia

A

Mass of new cells which proliferate without control and serve no useful function

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22
Q

Anaplasia

A

loses resemblance to cell of origin

AKA tumor or cancer

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23
Q

malignant tumor

A
  • A malignant tumor can metastasize into lymph nodes & distant organs
  • if untreated, may kill the patient wherever it occurs.
  • infiltrates the surrounding tissue.
  • when is excised, it may recur.
  • a malignant tumor grows more rapidly than a benign tumor.
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24
Q

Benign tumor

A
  • Usually a benign tumor may only cause death if it happens to grow in a vital organ.
  • grows by expansion and is usually separated from the surrounding tissue by a capsule.
  • if removed, it usually does not recur.
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25
Q

Carcinoma

A

Epithelial tissue

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26
Q

Sarcoma

A

Tumor of CT (derived from mesoderm), which develops into cartilage and bone (choristoma), fat (lipoma), and muscle (myoma)

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27
Q

Hemangioma

A

Tumor comprised of blood vessels/vasculature

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28
Q

Lymphoma

A

Tumor of lymphatic tissue (leukemia – hematopoietic cells affected)

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29
Q

Melanoma

A

Tumor of pigmented cells

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30
Q

Hamartoma

A

Tumor made of tissue normally present there

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31
Q

Blastoma

A

Tumor derived from embroyonic cells (i.e. retinoblastoma)

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32
Q

tumor tx

A

Chemotherapy
Cryotherapy
Radiotherapy
Surgery

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33
Q

Neoplastic considerations - Subjective

A
  • Lesion does not act or respond as anticipated
    HX of other skin lesions elsewhere on the body and other neoplasias or systemic disease
    -Pts. with HX of excessive UV skin exposure
    Lesion is not common for patient’s age, sex, race, demography
    -Older patients
    -FHX of skin cancers
    -Fair-complexion pts.
    -Acute vs. chronic onset & duration
    -Rapid or irregular growth patterns
    -Pain or irritation associated with suspicious lesion
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34
Q

Neoplastic considerations - Objective

A
  • Quality of the tissue looks irregular
  • Bleeding or ulceration of lesion
  • Surface integrity & quality questionable
  • Changes in lesion not consistent or predictable
  • Neovascular patterns around or within lesion
  • Recurrent infections or inflammations at site
  • Uncharacteristically large lumps or bumps
  • Associated tearing or conjunctival hyperemia
  • Erosion of the margins or surface of a lesion
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35
Q

Neoplastic Considerations - Assessment / DDX and Plan/TX

A
  • With serious doubt or suspicion regarding any lump or bump of the lid, recommend excision and biopsy
  • If referral deferred or refused for any reason, document and monitor closely
  • -Photodocument if possible
  • -Diagram/measure accurately
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36
Q

If suspicious of neoplastic

Rule of thumb :

A 
Asymmetry
Borders
Color
Diameter
(Elevation) Evolving
37
Q

Ephilis

A 
= freckle
-Plural: ephilides
-Larger sized melanocytes (normal in number)
-Autosomal dominant
inheritance pattern
-Intensified by sun exposure
38
Q

Solar lentigines

A

= “liver spots”, age spots

  • Occur in response to sunlight
  • Persist in the absence of sunlight
  • Middle aged to older patients
  • Expanding macules (flat patches)
  • Normal number of melanocytes
39
Q

Simple lentigines

A

Unlike solar lentigines, simple lentigines:

  • Occur at any age
  • Have no predilection for sun-exposure or lighter skin type
  • Do not darken in response to sunlight
40
Q

Solar lentigines laser Tx

A

Mechanism:
Pressure waves fragment pigment particles

Outcome:
Lesions darken or grey over several days to weeks before sloughing off

41
Q

Nevus

A

= mole

  • Plural: nevi
  • common benign neoplasms or melanocytes

Congenital or early onset
Occasional changes in size or pigmentation
Cosmetic concern

42
Q

Nevus Subjective:

A
  • Congenital or early onset
  • Occasional changes in size or pigmentation
  • Cosmetic concern
43
Q

Nevus - Objective: dermal

A

Most common
Located in dermis
Raised or flat

44
Q

Nevus - Objective: junctional

A
  • Dermoepidermal junction
  • Superficial
  • Usually flat
  • May convert to melanoma
45
Q

Nevus - Objective:

Compound

A
  • Both in dermoepidermal junction and dermis

- Transitional

46
Q

Nevus – Dysplastic

A

-“Fried egg” appearance
-Increased melanoma risk if multiple and with +FHx of melanoma
-Pigmented or amelanotic
-Commonly found at lid margins
Borders
-Less than 8 - 10 mm diameter
-May increase in size with aging
-Occasionally show hairs growing through surface

47
Q

Nevus - Assessment/DDx

A

-R/O other pigment spots

Plan:
-Photodocument or diagram and measure
Monitor q. 3 - 6 months if suspicious
-RTC q. year if normal appearance with no change
-Refer for biopsy if changes occur

48
Q

Malignant Melanoma

A
  • Malignant tumor derived from melanocytes
  • These comprise ~ 3% of primary skin cancers…
  • but accounts for 79% of skin cancer related deaths!
49
Q

Malignant Melanoma - Subjective

A
  • May not directly relate to UV exposure

- Light complexion

50
Q

Malignant Melanoma - Objective

A
  • Asymmetric, pigmented lesion with irregular borders
  • Variable coloration
  • Variable diameter

2 types: superfocial spreadinf melanoma, nodular melanoma

51
Q

Superficial spreading melanoma

A

Rapid increase in size

Lower incidence in metastases

52
Q

Nodular melanoma

A

Vertical growth with more penetration into tissue

Metastasize early

53
Q

Malignant Melanoma Mortality via Clark’s levels

-Level I:

A

-Level I: epidermis; called “in situ” melanoma; 100% cure

54
Q

Malignant Melanoma Mortality via Breslow depth

A
  • 0.75 mm deep 0% metastases
  • 0.85 mm deep 97% survival in 10 years
  • 3.6 mm deep 50% dead in 10 years
55
Q

Malignant Melanoma Mortality via Clark’s levels

-Level II:

A

invasion of the papillary (upper) dermis

56
Q

Malignant Melanoma Mortality via Clark’s levels

-Level III:

A

filling papillary dermis, not reticular (lower) dermis

57
Q

Malignant Melanoma Mortality via Clark’s levels

-Level IV:

A

invasion of reticular dermis ~50% dead in 10 yr

58
Q

Malignant Melanoma Mortality via Clark’s levels

-Level V:

A

invasion of the deep, subcutaneous tissue

59
Q

Epiluminescence Microscopy (ELM)

A
  • Typically x10 mag
  • Oil medium between instrument and skin
  • Allows inspection unobstructed by skin surface reflections
  • Makes subsurface structures viewable in vivo
  • New versions use polarized light to cancel reflections
  • Allows magnified visualization of pigmented skin lesions beyond what is visible in normal clinical exam
  • Designed for small equivocal pigmented skin lesions
60
Q

Mohs Surgery

A

lesion and normal around is cut to diagnose and treat entire lesion

61
Q

basal cell carcinoma definition

A

-most malignant lid tumor

62
Q

basal cell carcinoma etiology

A

UV exposure connection, elderly, fair skin (rare in darkly-pigmented people)

63
Q

basal cell carcinoma Location

A

1 place at inferior nasal

64
Q

basal cell carcinoma two types

A
  • Sclerosing

- Noduloulcerative

65
Q

what does early form of basal cell carcinoma look like

A

vascularized nodules

66
Q

basal cell carcinoma presentation

A
  • Varying degrees of central umbilicated ulceration
  • ”Pearly”, rolled borders
  • Pigmentation
  • Surface may become inflamed, infected or both
67
Q

sclerosing type

A
  • more scab like

- tends to happen on nasal side

68
Q

Basal Cell Carcinoma Assessment/DDX

A
  • Metastasis uncommon
  • Inner canthal lesions require more rapid attention
  • Consider all lid lumps & bumps!
  • —Keratoacanthoma
  • —HSV lesion
69
Q

Basal Cell Carcinoma Plan/TX

A
  • If secondarily infected or inflamed, run short course of AB steroid combo
  • Derm. consult
  • surgical excision & repair
  • radiation
  • cryotherapy (liquid nitrogen)
  • curettage
  • electrodessication
  • Imiquimod cream (antimetabolite) (Aldara)
  • 5-FU (fluorourocil) (antimetabolites- helps prevents proliferation of cells after surgery)
  • PDT (photodynamic therapy)
  • Pt. education
70
Q

Squamous Cell Carcinoma definition

A
  • 3RD MOST COMMON OCULAR TUMOR
  • 2nd most common skin cancer
  • easily confused with basal cell
  • flat more linear
71
Q

Squamous Cell Carcinoma etiology

A

Keratinizing epidermal cells

72
Q

Squamous Cell Carcinoma subjective

A

scab that doesn’t heal

73
Q

Squamous Cell Carcinoma objective

A

reddish, raised scaly plaque

74
Q

Squamous Cell Carcinoma Assessment/DDX

A
  • R/O all lid lumps & bumps!
  • -Keratoacanthoma
  • -sebborheic keratoses
  • -cutaneous warts
75
Q

Squamous Cell Carcinoma plan/tx

A

excision, radiation, PDT (photo- dynamic therapy)

76
Q

Meibomian Gland Carcinoma definiton

A
  • very rare
  • Mistaken for persistent, recurrent meibomian gland chalazion
  • A type of sebaceous gland carcinoma
  • Can mimic a chronic eyelid/conjunctival infection (preseptal)
  • lipid layer destroyed
77
Q

Meibomian Gland Carcinoma definiton plan/tx

A

Excision

Radiation

78
Q

precursor to cancer Actinic Keratosis

A

= solar keratosis = “sun spots”

Squamous cell dysplasia

79
Q

Actinic Keratosis etiology

A

UV exposure

80
Q

Actinic Keratosis subjective

A

Pt unaware

Pt notices ‘skin spots’

81
Q

Actinic Keratosis objective

A

Dry, scaly lesions 2-5 mm

Minimally elevated

82
Q

Actinic Keratosis

Assessment:

A
  • R/O neoplasia
  • R/O keratoacanthoma
  • R/O melanoma, nevi, verrucae, papilloma
  • R/O seborrheic keratoses
83
Q

Actinic Keratosis plan/tx

A
  • Dermatology consult

- Cryo, cutterage, topical anti-cancer cream (e.g. imiquimod), PDT

84
Q

Keratoacanthoma definiton

A

Papular lesion originating from sebaceous glands

Benign proliferation of squamous epidermal cells

85
Q

Keratoacanthoma etiology

A

unknown (possibly UV, trauma, age)

86
Q

Keratoacanthoma subjective

A

fast growing

87
Q

Keratoacanthoma objective

A
  1. Starts as erythematous papule
  2. Grows into firm, raised indurated nodule
    - up to 2 cm
  3. Keratin filled crater
  4. Color
  5. Spontaneously regresses
88
Q

Keratoacanthoma assesment

A

R/O SCC

89
Q

Keratoacanthoma Plan/TX

A

Derm. consult, excision

Ocular Disease (7 decks)

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