Eyelids

Question 1

Syringomas are?

Answer 1

benign proliferations arising from eccrine sweat
glands.

Question 2

Syringomas are characterized by_______ that are often _______ and _______.

Answer 2

small papules that are often
multiple and bilateral.

Question 3

_____ is the most common hair follicle proliferation seen by ophthalmologists.

Answer 3

Pilomatricoma

Question 4

Two other names for Pilomatricoma

Answer 4

Pilomatrixoma, calcifying epithelioma of Malherbe

Question 5

Pilomatricoma is derived from _______.

Answer 5

the germinal matrix cells of the hair bulb

Question 6

Pilomatricoma affects ______ (2)_______ and is more common
in ______.

Answer 6

children and young adults and is more common
in females.

Question 7

Pilomatricoma: Clinically it appears as a ________

Answer 7

mobile purplish dermal nodule that may have a hard consistency
due to calcification

Question 8

Pilomatricoma: Malignant change is ______. The lesion is usually ________.

Answer 8

rare, removed surgically.

Question 9

Other less common disorders of hair follicle proliferation include____(3)_____.

Answer 9

trichofolliculoma, trichoepithelioma, and trichilemmoma.

Question 10

Capillary haemangioma (strawberry naevus) is one of the most
common tumors in _____. It is three times as common in _______.

Answer 10

infancy, girls

Question 11

Capillary haemangioma: It presents shortly after birth as a unilateral, raised bright
red lesion (Fig. 2.13B), usually in the upper lid.

Question 12

Capillary haemangioma: A deeper lesion appears______.

Answer 12

purplish.

Question 13

Capillary haemangioma: The lesion blanches on pressure and may swell on crying.

Question 14

Capillary haemangioma: Ptosis is frequent and there may be orbital extension

Question 15

Capillary haemangioma: Occasionally the lesion may involve the skin of the face and some patients have strawberry naevi on other parts of the body.

Answer 15

It is important to be aware of an association between multiple cutaneous lesions and visceral haemangiomas and to consider systemic assessment in appropriate cases.

Question 16

A capillary haemangioma can be easily and successfully treated by regular application of a topical beta-blocker to the affected lesion.

Question 17

Port-wine stain (naevus flammeus) is a congenital malformation of
vessels within the superficial dermis

Question 18

Port-wine stain: consisting histopathologically

Answer 18

of vascular spaces of varying calibre separated by thin fibrous septa

Question 19

Port-wine stain: About 10% have associated ocular or CNS involvement,
including Sturge–Weber (see below) and other defined
syndromes.

Question 20

Port-wine stain manifests clinically as a sharply demarcated soft
pink patch that does not blanch with pressure, most frequently
located on the face.

Question 21

It is usually unilateral and tends to be aligned
with the skin area supplied by one or more divisions of the
trigeminal nerve

Question 22

Darkening to red or purple
takes place with age and there is commonly associated soft tissue
hypertrophy (Figs 2.14D–F). Bleeding may occur from focal overlying
lobulations (pyogenic granulomas – see below).

Question 23

Treatment with laser (e.g. pulsed-dye) is effective in decreasing
skin discoloration, particularly if undertaken early. Topical
preparations such as imiquimod and rapamycin, alone or with
adjuvant laser, show promise. Soft tissue debulking is used in a
small number of cases. Screening for glaucoma should begin in
infancy. Systemic investigation is considered in some patients,
particularly those with a lesion of the lumbar area.

Question 28

Sturge–Weber syndrome (encephalotrigeminal angiomatosis) is a congenital, sporadic phacomatosis.

Question 29

Sturge–Weber syndrome: consists of ____(3)_____

Answer 29

Port-wine stain, Leptomeningeal haemangioma, Ocular features.

Question 30

Sturge–Weber syndrome: Port-wine stain, extending over the area corresponding to the distribution of one or more branches of the trigeminal nerve.

Question 31

Sturge–Weber syndrome: Leptomeningeal haemangioma involving the ipsilateral parietal or occipital region may cause contralateral focal or generalized seizures, hemiparesis or hemianopia.

Question 32

Sturge–Weber syndrome: Ocular features may include ipsilateral glaucoma, episcleral haemangioma, iris heterochromia and diffuse choroidal haemangioma (see Ch. 20).

Question 33

Pyogenic granuloma is a rapidly growing vascularized proliferation of granulation tissue

Question 34

Pyogenic granuloma is usually antedated by surgery, trauma or infection, although some cases are idiopathic

Question 35

Pyogenic granuloma: Clinically there is a painful, rapidly growing, vascular granulating polypoidal lesion (Fig. 2.15) that may bleed following relatively trivial trauma. Cutaneous lesions should be excised.

Question 36

Cutaneous neurofibromas are_______

Answer 36

benign nerve tumours, usually nodular or pedunculated, that can be found anywhere on the skin.

Question 37

Plexiform neurofibromas typically present in childhood as a manifestation of neurofibromatosis type 1 with a characteristic S-shaped deformity of the upper eyelid

Question 38

Cutaneous neurofibromas: Treatment of solitary lesions involves simple excision, but removal of the more diffuse plexiform lesions may be difficult.

Question 39

Rare predisposing conditions of eyelid malignancies are ____(6)____

Answer 39

Xeroderma pigmentosum, Gorlin–Goltz syndrome, Muir–Torre syndrome, Bazex syndrome, immunosuppression, prior retinoblastoma, and albinism.

Question 40

Xeroderma pigmentosum is characterized by_________.

Answer 40

skin damage on exposure to sunlight, leading to progressive cutaneous abnormalities

Question 41

Xeroderma pigmentosum: More than 90% have ocular or periocular involvement and 65% experience photophobia.

Question 42

Xeroderma pigmentosum: Affected patients have a bird-like facial appearance and a significant propensity to the development of basal cell carcinoma (BCC), squamous cell carcinoma (SCC) and melanoma

Question 43

Xeroderma pigmentosum: It is inherited in an autosomal recessive (AR) fashion.

Question 44

Gorlin–Goltz syndrome (naevoid BCC syndrome) is a rare disorder characterized by _______ (Fig. 2.17B) and

Answer 44

by extensive congenital deformities of the eye, face, bone, and central nervous system.

Question 45

Gorlin–Goltz syndrome (naevoid BCC syndrome): It is inherited in an______

Answer 45

autosomal dominant (AD)

Question 46

Gorlin-–Goltz syndrome (naevoid BCC syndrome): Many patients develop multiple small BCC during the second decade of life.

Question 47

Gorlin–Goltz syndrome (naevoid BCC syndrome): Patients are also predisposed to medulloblastoma, breast carcinoma, and Hodgkin lymphoma.

Question 48

Muir–Torre syndrome is a rare AD condition that predisposes to ____(2)____

Answer 48

cutaneous and internal malignancies.

Question 49

Muir–Torre syndrome: Cutaneous tumours include BCC, sebaceous gland carcinoma and keratoacanthoma.

Question 50

Muir–Torre syndrome: Colorectal and genitourinary carcinomas are the most common systemic tumors.

Question 51

Muir–Torre syndrome: It is inherited in an______

Answer 51

AD fashion

Question 52

Bazex syndrome can be used to describe two distinct conditions:

Answer 52

Bazex–Dupré–Christol syndrome, acrokeratosis paraneoplastica of Bazex

Question 53

Acrokeratosis paraneoplastica of Bazex, in which ____________ lesions are associated with an underlying malignancy of________

Answer 53

eczema-like and psoriatiform, the upper respiratory or digestive tract.

Question 54

Bazex–Dupré–Christol syndrome: a condition characterized by multiple BCCs, commonly facial including the eyelids

Question 55

Bazex–Dupré–Christol syndrome: associated with skin changes including follicular indentations without hairs on extensor surfaces (follicular atrophoderma), hypohidrosis and hypotrichosis.

Question 56

Bazex–Dupré–Christol syndrome: It is inherited in an______

Answer 56

X-linked dominant fashion

Question 57

BCC is the most common human malignancy and typically affects older individuals.

Question 58

Ninety per cent of cases occur in the head and neck and about 10% of these involve the eyelid.

Question 59

BCC is by far the most common malignant eyelid tumour, accounting for 90% of all cases.

Question 60

It most frequently arises from the lower eyelid, followed in relative frequency by the medial canthus, upper eyelid and lateral canthus.

Question 61

Tumours located near the medial canthus are more prone to invade the orbit and sinuses, are more difficult to manage than those arising elsewhere and carry the greatest risk of recurrence.

Question 62

Tumours that recur following incomplete treatment tend to be more aggressive.

Question 63

Eyelid BCC conforms to one of the morphological patterns:

Answer 63

Nodular BCC, Nodulo-ulcerative BCC (rodent ulcer), Sclerosing (morphoeic) BCC, Other types.

Question 64

Nodular BCC is a shiny, firm, pearly nodule with small overlying dilated blood vessels. Initially, growth is slow and it may take the tumour 1–2 years to reach a diameter of 0.5 cm

Question 65

Nodulo-ulcerative BCC (rodent ulcer) is centrally ulcerated with pearly raised rolled edges and dilated and irregular blood vessels (telangiectasis) over its lateral margins (Fig. 2.19C). With time it may erode a large portion of the eyelid

Question 66

Sclerosing (morphoeic) BCC is less common and may be difficult to diagnose because it___________.

Answer 66

infiltrates laterally beneath the epidermis as an indurated plaque. The lesion tends to be much more extensive on palpation than inspection.

Question 67

Other types not usually found on the lid are cystic, adenoid, pigmented and multiple superficial.

Question 68

Sclerosing BCC can mimic a localized area of unilateral chronic blepharitis.

Question 69

sclerosing BCC may simulate a localized area of chronic blepharitis.

Question 70

SCC metastasis to regional lymph nodes in about 20% of cases

Answer 70

Careful surveillance of regional lymph nodes is therefore an important aspect of initial management.

Question 71

SCC The tumour may also exhibit perineural spread to the intracranial cavity via the orbit.

Question 72

SCC accounts for 5–10% of eyelid malignancies and may arise de novo or from pre-existing actinic keratosis or carcinoma in situ (Bowen disease, intraepidermal carcinoma

Question 73

Immunocompromised individuals, such as those with acquired immunodeficiency syndrome (AIDS) or following renal transplantation are at increased risk, as are those with a predisposing syndrome such as xeroderma pigmentosum.

Question 74

The tumour has a predilection for the lower eyelid and the lid margin. It occurs most commonly in older individuals with a fair complexion and a history of chronic sun exposure.

Question 75

Ostensibly benign lesions such as keratoacanthoma and cutaneous horn may reveal histological evidence of SCC in deeper levels of sectioning.

Question 76

Keratoacanthoma is a __________

Answer 76

rare, rapidly growing but subsequently regressing tumour

Question 77

Keratoacanthoma usually occurs in ____(2)____. _______ is also a predisposing factor.

Answer 77

usually occurs in fair-skinned individuals with a history of chronic sun exposure. Immunosuppressive therapy is also a predisposing factor.

Question 78

Keratoacanthoma Invasion and metastasis are ______.

Answer 78

rare.

Question 79

Keratoacanthoma: A sharp transition from the thickened involved area to normal adjacent epidermis is referred to as ______, and a __________ may be seen.

Answer 79

shoulder formation and a keratin-filled crater may be seen.

Question 80

Keratoacanthoma appearance: (Fig. 2.22D). Complete involution may take up to a year and usually leaves an unsightly scar.

Answer 80

A pink dome-shaped hyperkeratotic lesion develops

Question 81

Keratoacanthoma location:

Answer 81

often on the lower lid

Question 82

Keratoacanthoma timeline:

Answer 82

may double or treble in size within weeks. Growth then ceases for 2–3 months, after which spontaneous involution occurs, when a keratin-filled crater may develop.

Question 83

Keratoacanthoma - Complete involution may take up to ______ and usually leaves an unsightly scar.

Answer 83

a year

Question 84

Sebaceous gland carcinoma (SGC) is a very rare, slowly growing tumour that most frequently affects the _____, with a predisposition for _____.

Answer 84

elderly, with a predisposition for females

Question 85

SGC usually arises from the _______, although on occasion it may arise from the ________.

Answer 85

meibomian glands, glands of Zeis or elsewhere.

Question 86

SGC - Pagetoid spread refers to _______ and is not uncommon.

Answer 86

extension of a tumour within the epithelium

Question 87

SCG Overall mortality is _____

Answer 87

5–10%.

Question 88

SCG Adverse prognostic features include

Answer 88

upper lid involvement, tumour size of 10 mm or more and duration of symptoms of more than 6 months.

Question 89

In contrast to BCC and SCC, SGC occurs more commonly on _________.

Answer 89

the upper eyelid where meibomian glands are more numerous.

Question 90

SGC - There may be simultaneous involvement of __________.

Answer 90

the lower and upper lid on one side (5%).

Question 91

Yellowish material within a tumor is highly suggestive of ______.

Answer 91

SGC.

Question 92

Nodular SGC presents as a _________________, most commonly within the ____________.

Answer 92

as a discrete, hard nodule, most commonly within the upper tarsal plate

Question 93

Nodular SGC may exhibit yellow discoloration due to the presence of ______.

Answer 93

lipid.

Question 94

Nodular SGC may be mistaken for a

Answer 94

chalazion.

Question 95

Spreading SGC infiltrates into the______ and causes a _________ often with _______ and can be mistaken for blepharitis.

Answer 95

dermis, diffuse thickening of the lid margin, eyelash distortion and loss

Question 96

SGC can be confused with

Answer 96

chronic or recurrent localized meibomian gland inflammation.

Question 97

Clinically lentigo maligna presents as a _____________

Answer 97

slowly expanding pigmented macule with an irregular border.

Question 98

Lentigo maligna: Treatment is usually by_________.

Answer 98

excision.

Question 99

Lentigo maligna: _____(2)____are highly suggestive of malignant transformation.

Answer 99

Nodular thickening and areas of irregular pigmentation

Question 100

Lentigo maligna (melanoma in situ, intraepidermal melanoma, Hutchinson freckle) is an uncommon condition that develops in____(2)____.

Answer 100

sun-damaged skin in elderly individuals.

Question 101

Superficial spreading melanoma is characterized by a plaque with an irregular outline and variable pigmentation

Question 102

Nodular melanoma is typically a _____ surrounded by normal skin

Answer 102

blue-black nodule

Question 103

Melanoma: Treatment is usually by _____and may include ______.

Answer 103

wide excision, local lymph node removal.

Question 104

Melanoma: Early detection carries a good prognosis and _______ is often curative

Answer 104

surgical excision

Question 105

Melanoma: ________ are of limited efficacy, but new approaches using ______ are showing considerable promise.

Answer 105

Radiotherapy and chemotherapy, immunotherapy

Question 106

Merkel cells are a form of sensory receptor concerned with ______.

Answer 106

light touch.

Question 107

Merkel cell carcinoma is a _____ tumour that typically affects ______.

Answer 107

rapidly growing, highly malignant, older adults.

Question 108

Merkel cell carcinoma: ____% of patients have metastatic spread by presentation.

Answer 108

50%

Question 109

Merkel cell carcinoma: most frequently involving the _______.

Answer 109

upper eyelid

Question 110

Merkel cell carcinoma: Treatment is by _________.

Answer 110

excision, often with adjuvant therapy.

Question 111

Kaposi sarcoma is a ________ that typically affects individuals with AIDS.

Answer 111

vascular tumor

Question 112

Kaposi sarcoma: presents clinically as_______, which may be mistaken for a haematoma or naevus.

Answer 112

a pink, red-violet to brown lesion

Question 113

Kaposi sarcoma: Treatment is by ____(3)____

Answer 113

radiotherapy or excision and by optimal control of AIDS.

Question 114

Kaposi sarcoma: may be mistaken for ____(2)____.

Answer 114

haematoma or naevus.