AED - Lumps and Bumps IV - Week 4

Question 1

Briefly describe the anatomy of the following glands:
Zeis
Moll
Meibomian
Wolfring
Krause
Describe each of them in terms of where they are found in the eyelid and, in order of anterior to posterior, where their openings are.

Answer 1

Zeis - sits at the base of the eyelash, most anterior
Moll - small gland whose opening is found between Zeis and Meibomian
Meibomian - opening found in the middle of the eyelid margin base, the gland extends superiorly throughout the tarsal plate in a line
Wolfring - the gland is found superior to the Meibomian gland, and opens onto the superior bulbar conjunctiva from inside the eyelid
Krause - gland and opening found at the fold between the tarsal and bulbar conjunctiva deep within the eyelid

Question 2

Is the gland of Moll a hair follicle?

Answer 2

Yes

Question 3

What is an inclusion cyst? Is it hard or soft? Is it translucent or not?

Answer 3

An entrapment of epithelial cells that secrete

Harder than fluid filled and not translucent

Question 4

Can inclusion cysts be conjunctival?

Answer 4

Yesd

Question 5

How does a cyst of moll appear? Is the fluid clear and is the cyst itself translucent or not?

Answer 5

It is a swelling at the lid margin, with clear fluid inside, and appears like a translucent balloon

Question 6

Describe what milia look like and why they appear.

Answer 6

They are keratin cysts that appear as multiple hard pimples

Question 7

Can sweat glands be blocked and form cysts?

Answer 7

Yes, multiple flat lesions or a very large balloon about the eye with milky fluid

Question 8

Are cysts of Zeis and Moll tender?

Answer 8

No

Question 9

What do Zeis cysts contain? What colour?

Answer 9

Contains fat, slightly yellow/white

Question 10

Are Zeis cysts painful?

Answer 10

No

Question 11

Are Zeis cysts opaque or translucent? What about Moll cysts?

Answer 11

Zeis are opaque, Moll are translucent

Question 12

Do Zeis cysts contain a lash?

Answer 12

Yesd

Question 13

Is a stye or hordeolum tender/painful?

Answer 13

Yes

Question 14

What is a stye/hordeolum?

Answer 14

Infection of the gland of Zeis

Question 15

How are styes and hordeolums managed? What about if they dont go away?

Answer 15

Warm compresses, most resolve within 2-3 days

Topical broad spectrum antibiotics can be used if persistent

Question 16

How does a chalazion form?

Answer 16

Chronic bacterial activity at the opening of a meibomian gland results in blockage and buildup of meibomian secretion, which appears as a bump in the eyelid.

Question 17

Are chalazions painful?

Answer 17

No

Question 18

Are chalazions typically uni- or bilateral?

Answer 18

Unilateral

Question 19

Are chalazions typically recurrent?

Answer 19

Yesd

Question 20

Over what period of time do chalazions develop?

Answer 20

Several weeks

Question 21

Are chalazions firm or soft?

Answer 21

Firm

Question 22

In what three conditions are chalazions common?

Answer 22

Blepharitis
Acne rosacea
Seborrhoeic dermatitis

Question 23

What kind of inflammation occurs in chalazions?

Answer 23

Chronic granulomatous inflammation

Question 24

What are the four main cell types seen in the inflammation occuring ith chalazions?

Answer 24

Plasma cells
Neutrophils
Lymphocytes
MN giant cells

Question 25

How would you rule out a sinister lesion with a case of chalazion?

Answer 25

Check for blood vessel feeders

Question 26

What happens to chalazions eventually?

Answer 26

Spontaneous resolution in a few months when fluid is resorbed

Question 27

What are two general treatment options for chalazion treatment? What about if it is recurrent?

Answer 27

Heat compresses and lid massages | Tetracycline if recurrent

Question 28

What is a treatment option for long-lasting chalazions?

Answer 28

Incision with currettage | Steroid injection

Question 29

In which gender and age group is sebaceous gland carcinoma more common in?

Answer 29

Elderly females, upper eyelid

Question 30

List 4 signs of sebaceous gland carcinoma.

Answer 30

Chronic non-healing blepharitis Multi-lobed, red/irritated, recurrent mass for months to years Loss of lashes and eyelid structure

Question 31

What does a sebaceous gland carcinoma resemble?

Answer 31

Long lasting chalazion

Question 32

What is a verruca?

Answer 32

Viral wart

Question 33

What are the two forms of verruca?

Answer 33

Small papule with a lumpy surface and broad base | Elongated filiform

Question 34

What virus is responsible for causing molluscum contagiosum? What appearance does this infection have?

Answer 34

Viral infection caused by pox virus | A wart-like lesion but less prominent - dome shaped papule

Question 35

List 4 symptoms of molluscum contagiosum. Can it be asymptomatic?

Answer 35

``` Mild photophobia Lacrimation VA drop Hyperaemia Can be asymptomatic ```

Question 36

How is molluscum contagiosum managed (2)?

Answer 36

Counsel goo hygiene | Refer large lesions for excision

Question 37

What appearance does a keratoacathoma have?

Answer 37

A raised nodule with a central crater, resembling a volcano

Question 38

Do keratoacanthoma have a halo?

Answer 38

No

Question 39

In what age population is a keratoacantoma more likely?

Answer 39

Middle aged/eldery

Question 40

What is a risk factor for keratoacanthoma?

Answer 40

Sun-damaged skin

Question 41

What is found at the centre of a keratoacanthoma?

Answer 41

Keratin core

Question 42

How does a keratoacanthoma grow?

Answer 42

Grows rapidly initially over 2-6 weeks

Question 43

What is the management for keratoacanthoma?

Answer 43

Refer for excision and biopsy

Question 44

How would SCC be excluded for a suspected case of keratoacanthoma (2)?

Answer 44

Crater and halo | Find the keratin core with biopsy

Question 45

What is a xanthelasma?

Answer 45

Benign, lipid filled tumour

Question 46

How does xanthelasma appear?

Answer 46

Soft yellowish plaques

Question 47

Are xanthelasma uni- or bilateral? Are they found medially on the eyelid or temporally?

Answer 47

Often bilateral, on the medial aspect

Question 48

What do xanthelasma follow?

Answer 48

The folds of skin

Question 49

Are xanthelasma permanent? Do they grow rapidly?

Answer 49

Often permanent and grow slowly

Question 50

What age group is more likely to get xanthelasma?

Answer 50

Middle aged / elderly

Question 51

In what two conditions may xanthelasma occur?

Answer 51

Hypercholesterolaemia and lipoprotein disorders

Question 52

How are xanthelasma managed (2)?

Answer 52

Refer to GP for systematic lipid profile | Consider referral for excision for cosmesis if recurrent and biopsy

Question 53

What is seborrhoeic keratosis?

Answer 53

A benign epithelial tumour

Question 54

Are seborrhoeic keratoses symptomatic or aymptomatic?

Answer 54

Usually asyptomatic

Question 55

What are seborrheic keratoses caused by?

Answer 55

UV damage

Question 56

How long are seborrheic keratoses present for?

Answer 56

Months to years

Question 57

Can seborrheic keratoses grow larger?

Answer 57

They may slowly

Question 58

Are seborrheic keratoses common or rare before 30yo?

Answer 58

Rare

Question 59

How does seborrheic keratosis appear?

Answer 59

Small hard lesion above the skin surface which may be rough

Question 60

What happens with seborrheic keratosis histologically (2)?

Answer 60

Proliferation of basal epidermal cells | Keratin filled cysts

Question 61

What is the management for seborrheic keratosis?

Answer 61

Referral for excision, biopsy if suspicious

Question 62

What is solar or actinic keratosis?

Answer 62

Benign skin tumour

Question 63

How do solar/actinic keratoses appear?

Answer 63

Rough/scaly elevated lesion

Question 64

Can solar/actinic keratoses be malignant?

Answer 64

Yes there is poetential

Question 65

How are solar/actinic keratoses managed?

Answer 65

Refer for excision or biopsy as needed

Question 66

What is the histopathological difference between skin naevus and moles?

Answer 66

Same, but moles are small, naevus are larger

Question 67

Are skin naevus colourations even or uneven?

Answer 67

Even

Question 68

Are skin naevus flat or elevated?

Answer 68

Can be either

Question 69

Are skin naevus pigmented or unpigmented?

Answer 69

Can be either

Question 70

Which layer of skin are skin naevus typically found (3)?

Answer 70

Epidermis, dermis, rarely deeper (appears blue)

Question 71

What is the most common type of skin naevus?

Answer 71

Intradermal

Question 72

When do skin naevus appear?

Answer 72

Appears at puberty

Question 73

How can a skin naevus be distinguished from a malignant melanoma (9)?

Answer 73

``` Melanoma are: Raised nodule or plaque Has an active halo and variable in colour Increased size/thickness Irregular edges Inflammation Bleeding Satellite lesions Growth and rapid change ```

Question 74

How can a suspected malignant melanoma be managed?

Answer 74

Take yearly photos and watch closely | Refer for biopsy/excision if at all suspicious