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Flashcards in Adnexal Oncology Deck (38)
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1

What does adnexal mean?

From the latin "appendages"

-Orbit
-Eyelids
-Lacrimal Drainage System

Evereything around the eye which isnt the eye itself

2

How common are adnexal tumours?

Eyelid tumours
-Very common
-Up to 20% of Caucasians in their lifetime

Lacrimal Drainage Tumours
-Vanishingly Rare
-Less than 1 per 1,000,000 per year

Orbital Tumours
-Very rare
-2/3 benign, 1/3 malignant
-Approximately 1 per 100,000 per year

3

What is a tumour?

Abnormal proliferation of tissue

4

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

5

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"

6

Give some malignant tumour types

Carcinoma
Sarcoma
Lymphoma
Leukaemia
Blastoma

7

What is a Carcinoma?

Derived from epithelial cells (i.e. skin, respiratory, tract, GI tract)

8

What is a sarcoma?

Derived from connective tissue (i.e. bone, cartilage, fat, nerve)

9

What is a lymphoma?

Haemopoietic cells maturing in lymphatic tissue

10

What is leukaemia?

Haematopoietic cells maturing in blood

11

What is a blastoma?

Cancers derived from immature "precursor" cells or embryonic cells

12

List the benign eyelid tumours from common to rare

Squamous cell papilloma
Basal cell papilloma (seborrhoeic keratosis)
Melenocytic naevus
Actinic Keratosis
Pyogenuc Granuloma
Keratoacanthoma
Capillary Haemangioma
Cavernous haemangioma

13

List the malignant eyelid tumours from common to rare

Basal cell carcinoma (90-95%)

Squamous cell carcimona (2-5%)

Sebaceous gland carcinoma (1-2%)

Melanoma (

14

Explain Squamous cell papilloma

-Pedunculated or sessile (broad based)
-Characteristic "raspberry" texture
-Usually viral

Treatment by excision or laser ablation

15

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

16

What is Melanocytic Naevus?

Composed of atypical melanocytes

Location of these melanocytes influences clinical appearance and potential for malignant transformation

17

What are the different types of Melanocytic Naevus

Junctional: Black
-Epidermis
-Most rare malignant transformation

Compound: Brown
-Deep epidermis

Intradermal:
-Grey - Papillary dermis
-Blue - Dermis
----Malignant transformation rare

18

What is the early signs (+ concerning signs) of malignant transformation in Melanocytic Naevus?

Early signs of malignant transformation:
A- Asymmetry
B- Border (irregular)
C- Colour (Variegated)
D- Diameter (>6mm)
E- Evelving (growing)

Concerning
E- Elevated
F- Firm to touch
G- Growing

19

What is pyogenic granuloma?

-Fast growing, higjly vascularised granuloma
-May follow surgery, infection, (trivial) trauma
-Erythematous pedunculated mass

Rx = Excision

20

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)

21

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

22

What is capillary haemangioma?

-Although rare, one of the commonest tumours of infancy
-Predilection upper lid +/- orbital extension
-Amblyopia, astigmatism
-Involution from age 2, 40% by 4, 70% by 7

Rx = Beta-blockers, intralesion steroid, surgery

23

What is cavernous haemangioma?

-Rare, congenital
-Well demarcated pink patch
-Darkens with age, does not involute
-Sturge-weber

Rx = Laser

24

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

25

What are features suggestive of Basal Cell Carcinoma?

-Slow, inexorable growth over months
-Usually non-pigmented, elevated, ulcerated
-Pearly, rolled, irregular border
-Telangiectasia
-Lack of tenderness

26

What are the clinical subtypes of Basal cell carcinoma?

Nodular
-Common, classic pearly nodule

Ulcerative:
-Common, may cause progress from nudular cucles of crusting and bleeding

Morphaeform/ infiltrative:
-Less common, indurated plaques

27

What is the surgical management of Basal cell carcinoma?

Standard excision
-Margin
-Primary vs delayed closure

Mohs surgery

28

What is the non-surgical management of basal cell carcinoma?

-Topical (imiquimod, efudex)
-Chemo (visodegib)
-Cryotherapy
-Radiotherapy
-Photodynamic therapy

29

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

30

What is a Sebaceous Gland carcinoma?

-"Recurrent chalazion", "Unilateral blepharitis"
-Nodular, indurated lid margin
-Yellowish discolouration (lipid content)
-Pagetoid spread along conjunctiva

Rx = Excision