Flashcards in Adnexal Oncology Deck (38)
What does adnexal mean?
From the latin "appendages"
-Lacrimal Drainage System
Evereything around the eye which isnt the eye itself
How common are adnexal tumours?
-Up to 20% of Caucasians in their lifetime
Lacrimal Drainage Tumours
-Less than 1 per 1,000,000 per year
-2/3 benign, 1/3 malignant
-Approximately 1 per 100,000 per year
What is a tumour?
Abnormal proliferation of tissue
What is a benign tumour?
Normal cells in abnormal numbers and/or location
Cells lack the ability to invade local tissue or to metastasise
Typically slow growing
Main problems from mass effect
What is a malignant tumour?
Anaplastic cells (loss of form or function)
Often repidly growing, capable of invading surrounding tissue and spreading to distant locations.
Colloquially known as "cancer"
Give some malignant tumour types
What is a Carcinoma?
Derived from epithelial cells (i.e. skin, respiratory, tract, GI tract)
What is a sarcoma?
Derived from connective tissue (i.e. bone, cartilage, fat, nerve)
What is a lymphoma?
Haemopoietic cells maturing in lymphatic tissue
What is leukaemia?
Haematopoietic cells maturing in blood
What is a blastoma?
Cancers derived from immature "precursor" cells or embryonic cells
List the benign eyelid tumours from common to rare
Squamous cell papilloma
Basal cell papilloma (seborrhoeic keratosis)
List the malignant eyelid tumours from common to rare
Basal cell carcinoma (90-95%)
Squamous cell carcimona (2-5%)
Sebaceous gland carcinoma (1-2%)
Explain Squamous cell papilloma
-Pedunculated or sessile (broad based)
-Characteristic "raspberry" texture
Treatment by excision or laser ablation
Explain basal cell papilloma = Seborrhoetic keratosis
-Greasy, brown, flat, round/oval
-Similar texture to squamous cell papilloma
-"Stuck on" appearance
-Unrelated to sun exposure
Rx = Excision
What is Melanocytic Naevus?
Composed of atypical melanocytes
Location of these melanocytes influences clinical appearance and potential for malignant transformation
What are the different types of Melanocytic Naevus
-Most rare malignant transformation
-Grey - Papillary dermis
-Blue - Dermis
----Malignant transformation rare
What is the early signs (+ concerning signs) of malignant transformation in Melanocytic Naevus?
Early signs of malignant transformation:
B- Border (irregular)
C- Colour (Variegated)
D- Diameter (>6mm)
E- Evelving (growing)
F- Firm to touch
What is pyogenic granuloma?
-Fast growing, higjly vascularised granuloma
-May follow surgery, infection, (trivial) trauma
-Erythematous pedunculated mass
Rx = Excision
What is Actinic Keratosis?
-Common pre-malignant condition, though relatively rare on eyelids
-Flat, scaly, hyperkeratotic skin, occasionaly fomes cutaneus horn
-Related to sun exposure
Rx = Excision or medical traetment (resonds well to creams)
What is Keratoacanthoma?
-Rare, "squamous cell carcinoma in situ"
-Rapidly growing in otherwise healty skin
-Pink papule, hyperkeratotic crater
-Sun exposure, immunosuppression
-Often spontaneous involution after 2-3 months
Rx = Excision
What is capillary haemangioma?
-Although rare, one of the commonest tumours of infancy
-Predilection upper lid +/- orbital extension
-Involution from age 2, 40% by 4, 70% by 7
Rx = Beta-blockers, intralesion steroid, surgery
What is cavernous haemangioma?
-Well demarcated pink patch
-Darkens with age, does not involute
Rx = Laser
What are the epidemelogical features basal cell carcinoma?
-Commonest cancer worldwide
-Pale skin and sun exposure
-70% occur on the face
->100,000/year in UK
-Will affect up to 20% of Caucasians in their lifetimes
-Locally invasive, risk of metastasis about 1:1000
What are features suggestive of Basal Cell Carcinoma?
-Slow, inexorable growth over months
-Usually non-pigmented, elevated, ulcerated
-Pearly, rolled, irregular border
-Lack of tenderness
What are the clinical subtypes of Basal cell carcinoma?
-Common, classic pearly nodule
-Common, may cause progress from nudular cucles of crusting and bleeding
-Less common, indurated plaques
What is the surgical management of Basal cell carcinoma?
-Primary vs delayed closure
What is the non-surgical management of basal cell carcinoma?
-Topical (imiquimod, efudex)
What is squamous cell carcinoma?
-Sun damaged skin and pre existing AK
-Scaly surface over a thick plaque
-Growth over weeks rather than months
-Metastatic risk of 3-10%
Rx = Excision