3: Eyelids- Malignant Lesions

Question 1

signs of skin cancer: ABCDE rule

Answer 1

-Asymmetry: one half does not match the other
-Borders: indistinct borders (uneven, scalloped, notching)
-Color: various colors within the lesion, may be amelanotic
-Diameter/Disruption: 6 mm (size of pencil eraser) or larger; disruption of normal eyelid architecture (e.g., madarosis, poliosis, swelling or thickening of the eyelid)
Evolving: any change in size, shape, color, or elevation; bleeding, itching or crusting; new mole after age 40

Question 2

basal cell carcinoma

Answer 2

malignant tumor of the skin

Question 3

basal cell carcinoma etiology

Answer 3

• proliferation of atypical basal epithelial cells

- associated with UV exposure

Question 4

basal cell carcinoma demographics

Answer 4

• typically develops after the age of 50

- more common in Caucasians

Question 5

basal cell carcinoma laterality

Answer 5

unilateral

Question 6

basal cell carcinoma symptoms

Answer 6

• asymptomatic

- “bump” or mole, scab or “sore” on eyelid

Question 7

basal cell carcinoma signs

Answer 7

• variable appearance
• pink, shiny, firm, pearly nodule with small overlying blood vessels
• centrally ulcerated with pearly raised rolled edges
• firm, waxy yellow plaque with indistinct borders
• open sore
• most frequently involves the LL and medial canthus > UL and lateral canthus

Question 8

basal cell carcinoma complications

Answer 8

• orbital extension

- metastasis (extremely rare)

Question 9

basal cell carcinoma management

Answer 9

• refer for biopsy and surgical excision

- Moh’s surgery: 98% curative

Question 10

basal cell carcinoma clinical pearls:

• most common ____; 90% of cases involve ____ and ~10% of those involve _____
• most common ______; accounts for 90% of all cases

Answer 10

skin cancer;
head and neck;
the eyelid;
eyelid cancer/malignant tumor

Question 11

squamous cell carcinoma

Answer 11

malignant tumor of the skin

Question 12

squamous cell carcinoma etiology

Answer 12

• proliferation of atypical squamous epithelial cells

- associated with UV exposure, actinic keratosis, keratoacanthoma

Question 13

squamous cell carcinoma demographics

Answer 13

• typically develops after the age of 50

- more common in Caucasians

Question 14

squamous cell carcinoma laterality

Answer 14

unilateral

Question 15

actinic keratosis (AK, solar keratosis)

Answer 15

• majority of SCC cases arise from actinic keratosis
• pre-malignant small dry, scaly, or crusty patches of skin; feel dry and rough to touch; painful, itchy, burning sensation
• may be red, light or dark tan, white, pink, flesh-toned, or a combination
• refer for biopsy, as 5-10% of AKs transform into SCC

Question 16

keratoacanthoma

Answer 16

• pre-malignant variant of SCC
• clinically may resemble SCC and BCC
• characterized by rapid growth over a few weeks to months followed by slow regression and even spontaneous resolution in 4-6 months
• refer for biopsy and excision

Question 17

squamous cell carcinoma symptoms

Answer 17

• asymptomatic

- “bump” or scab/sore on eyelid

Question 18

squamous cell carcinoma signs

Answer 18

• variable appearance
• scaly red patch; may have crusting, scabbing, slight bleeding to margins
• rough, thickened, or wart-like skin
• raised growths with a central depression
• open sore
• most frequently involves the LL

Question 19

squamous cell carcinoma complications

Answer 19

• orbital extension

- metastasis (high risk of metastasis)

Question 20

squamous cell carcinoma management

Answer 20

• referral for biopsy and surgical excision

- Moh’s surgery (may not be curative, but a good start)

Question 21

squamous cell carcinoma clinical pearls:

• most _____ of all eyelid cancers
• 2nd most common ______
• 2nd most common ______; accounts for 5-10% of all cases

Answer 21

variable in presentation;
skin cancer;
eyelid cancer

Question 22

sebaceous gland carcinoma

Answer 22

malignant tumor of the sebaceous gland

Question 23

sebaceous gland carcinoma etiology

Answer 23

proliferation of atypical epithelial cells lining sebaceous glands

Question 24

sebaceous gland carcinoma demographics

Answer 24

typically develops after the age of 50

Question 25

sebaceous gland carcinoma laterality

Answer 25

unilateral

Question 26

sebaceous gland carcinoma symptoms

Answer 26

- asymptomatic | - "bump" in or on eyelid

Question 27

sebaceous gland carcinoma signs

Answer 27

- variable appearance - discrete hard nodule, yellow discoloration due to the presence of lipid - may resemble benign lesions: recurrent, recalcitrant chalazion; recalcitrant hordeolum; chronic unilateral, recalcitrant blepharitis - tends to spread along the conjunctival surface - most frequently involves the UL (more sebacous/MGs in UL than LL!)

Question 28

sebaceous gland carcinoma complications

Answer 28

- orbital extension | - metastasis (high risk of metastasis)

Question 29

sebaceous gland carcinoma management

Answer 29

referral for biopsy and surgical excision

Question 30

sebaceous gland carcinoma clinical pearls: - can develop in _____; most often affects ____ - represents <1% of _____ - overall mortality is _____ due to _____

Answer 30

any sebaceous gland; the meibomian glands; all eyelid tumors; 5-10%; metastasis

Question 31

melanoma

Answer 31

malignant tumor of the skin

Question 32

melanoma etiology

Answer 32

- proliferation of atypical melanocytes - develop from nevus - associated with UV exposure

Question 33

melanoma demographics

Answer 33

more common in Caucasians

Question 34

melanoma laterality

Answer 34

unilateral

Question 35

melanoma symptoms

Answer 35

- asymptomatic | - "bump" on eyelid; quick development (few weeks to few months); Hx of a nevus or mole, noticed change vs unaware

Question 36

melanoma signs

Answer 36

- variable appearance - flat or slightly raised and discolored, asymmetric patch with uneven borders - variable size, but greater concern if >6 mm - other malignant exam findings (ex: madarosis)

Question 37

melanoma complications

Answer 37

metastasis: strong propensity with lymphatic invasion; orbital extension; may involve other organ systems

Question 38

melanoma management

Answer 38

referral for biopsy and surgical excision

Question 39

melanoma clinical pearls: - can occur ____ - least common _____; represents 1% of all _____ - most _____ eyelid malignancy due to _____; accounts for the majority of _____ - 5-year survival rate is _____ if it is treated prior to metastasis; ____ if it spreads to the lymph nodes; _____ if spreads to distant body sites such as organs

Answer 39

``` anywhere on the skin; eyelid malignancy; eyelid tumors; fatal; metastasis; skin cancer deaths; 99%; 62%; 20% ```

Question 40

Kaposi's sarcoma

Answer 40

malignant tumor that usually appears on the skin or mucosal surfaces

Question 41

Kaposi's sarcoma etiology

Answer 41

proliferation of endothelial cells that line lymph or blood vessels in response to Kaposi sarcoma-associated herpesvirus (aka human herpesvirus 8, HHV-8)

Question 42

Kaposi's sarcoma demographics

Answer 42

- 4 types (defined by the population that acquire KS): - AIDS associated KS - Mediterranean KS - African KS - Transplant related KS

Question 43

Kaposi's sarcoma laterality

Answer 43

unilateral or bilateral

Question 44

Kaposi's sarcoma symptoms

Answer 44

- asymptomatic | - "bump" or plaque on the eyelid

Question 45

Kaposi's sarcoma signs

Answer 45

- purple, red, or brown nodule or papule | - can occur on the eyelid and/or conjunctiva

Question 46

Kaposi's sarcoma management

Answer 46

- refer out for treatment - HAART (highly active antiretroviral therapy) - if no improvement with HAART: surgical resection, radiotherapy, cryotherapy, intralesional chemotherapy

Question 47

Kaposi's sarcoma clinical pearls: - can occur _____; most often affects _____ - no treatment available to eradicate _____, therefore, not cure for ____ - purpose of therapy is directed at _____ - KS is considered an AIDS defining illness - infection with HHV-8 does not always lead to KS

Answer 47

anywhere on the skin or mucosal surfaces; the legs and face; HHV-8 infection; KS; improving cosmesis and slowing progression