Ocular Oncology Flashcards
What is basal cell carcinoma?
The most common type non melanomas skin cancer
What is the incidence of BCC?
3 million worldwide
What causes BCC?
UV exposure
What the risk factor for BCC?
Fair skin Sun exposure Previous BCC Rarely hereditary Elderly
What are the different BCC subtypes?
- Nodular
- Superficial
- Morphoic/infiltrative
- Pigmented
What are the signs to look out for in BCC?
- Rolled pearly edges
- Loss of lashes
- Ectropian/entropic
- Misdirected lashes
- Loss of normal lid margin
- Medial cantus popular location
Which is the worst type of BCC?
Pigmented. Can be mistaken for melanoma
What is the main treatment for BCC?
Surgical incision
What other BCC treatments are there?
Radiotherapy
Cryotherapy
Topical
Which treatment option for BCC gives a better cute rate?
Radiotherapy
What is the management for BCC?
Non urgent referral, seen in 3/12
What is another common non melanoma skin cancer?
Squamous cell carcinoma (SCC)
Where can SCC progress from?
De novo (Anew)
Untx actinic keratosis
Bowens disease
What is the cause of SCC?
Cumulative UV exposure
Immune suppression
Xerdema pigmentosa
Oculocutaneous albinism
What are the signs of SCC?
Thick, rough scaly patches Bleed Warts Produces keratin Increase rapidly in size
What big risk does SCC have?
Metastasize
What are the risk factors for mets?
Sun exposed area
Size >2mm
Depth >4mm
What is the treatment for SCC?
Excision and reconstruction
What is the management for SCC?
Urgent referral to oculoplastics- 2/52 wait. If neglected can turn into BCC
Name a type of malignant tumor found on the eyelid?
Sebaceous gland carcinoma
What does SGC resemble?
Blepharitis
Which glands are in question with SGC?
Glands of zeiss
Meibomian glands
What are the signs of SGC?
Madarosis
Nodular
Yellow colour
How is SGC managed?
Urgently referred to oculoplastics for excision- 2/52 wait
Where does conjunctival melanoma arise from?
- PAM (primary acquired melanosis)
- Naevis
- De novo
What are the signs of conjunctival melanoma?
Raised mass
Amelanotic, usually pigmented
Feeder vessel
Where can the conjunctival melanoma matestasize to?
Lymph nodes and brain
Why is dry technique used in surgery for SGC?
As to not spread the melanoma cells. Could spread
How is conjunctival melanoma managed?
Referred urgently= HES 2/52 wait
What surgical intervention is used to tx conjunctival melanoma?
Surgical excision
Cryotherapy
When does a conjunctival melanoma have a poor prognosis?
When its recurrent
What’s the key difference between PAM and a naevi?
PAM- Middle age
Naevi- 1st and 2nd decade
What is a reassuring sign of a naevi?
Clear cysts
If the naevi turned out to be a PAM, how would you know and what action would you take?
Documented growth Refer urgently (1/12) if hx suggests PAM
Where is a uveal melanoma located?
Uveal tract- commonest primary intraocular malignancy
What is the incidence of uveal melanoma?
5-7 mill population/yr
Where is the main site of a uveal melanoma?
Choroid (65%)
Ciliary body (30%)
Iris (5%)
What are the risk factors for iris melanoma?
Caucasian
What are the signs of iris melanoma?
Circumscribed, diffuse or amelontic
Deeply pigmented
Hyperchromic heterochromia
If an iris melanoma is suspected what action is taken?
Refer directly to HES
What different posterior uveal melanomas are there?
Ciliary body melanoma
Choroidal melanoma
Choroidal naevi
Intermediate melanocytic lesios (ILM)
What sign in particular would indicate a ciliary body melanoma?
Mass in red reflex
What other conditions that can followed by a ciliary body melanoma?
Cataracts
Retinal detachment
Lenti astigmatism
What 4 sxs are present in a choroidal melanoma?
Asymptomatic
Vision loss
Metamorphopsia
Photopsia
What are the signs of choridal melanoma?
Elevated lesion Pigmented Ret detach Breach in BM Subret fluid
How prevalent is a choroidal neavi?
Common prev of 5-10%
What are the signs of choroidal neavi?
Slate grey
Flat
Ill defined border
Surface druesen
What type melanoma is not considered to be a melanoma
ILM intermediate melanocytic lesions has low malignant potential
What is a common intraocular tumour especially in children?
Retinoblastoma
What key signs are found in reinoastoma?
Leukocoria
Strabismus
2nd glaucoma
Iris neovasc
Vit haemm
Pseudohypopyon
Orbital cellulitis
What are the early presentation of retinoblastoma?
What are the late and advanced signs of retinoblastoma?
