Flashcards in Lecture 8- Eyelid Disease: Benign Growths and Neoplasms Deck (20)
Small, raised, round and white cystic lesions filled with keratin, usually MANY of them, occur in infants, trauma, asymptomatic.
2. treatment for child or adult
2. Child - no treatment needed, Adult - incision and expression of content and then polysporin, follup up 1 week
Deep (epidermal inclusion cyst) or superficial infection of the infundibulum of the hair follicle - Gland of Zeis - lipid for eyelashes
2. Treatments for superficial and deep
1. Sebaceous cyst
2. Superficial - clean with alcohol, incise surface with needle or forceps, express with q tips, then apply polysporin
Deep - refer for excision/reassurance
Fluid cyst of Moll glands on lid margins, transparent, asymptomatic
1. Sudoriferous cyst
2. Lance with a small 20 gauge needle, then polysporin, follow up 1 week
Thickening of squamous cells, viral origin, gradual onset, can be planar, vulgaris, pedunculated, cutaneous horn, can cause viral conjunctivitis if on lid margin.
1. Name - General
2. Name for multi-lobular with wide base
3. Name for Wide base but not lobular
4. Name for finger like projections type
5. Name for type similiar to pedunculated but has keratin on top, horn shaped
1. Verrucae - Warts
2. Verrucae Vulgaris
3. Verrucae Plana - Flat wart
4. Pedunculated Verrucae
5. cutaneous horn
6. If on lid margin and conjunctivitis is present, refer for excision, educate patient, cryosurgery or laser can be done.
Most common benign lesion of the eyelid, hard to differentiate between vurrucae vulgaris, has PIGMENTATION that warts dont have. AKA SKIN TAG. non viral squamous cell thickening, commonly involve eye lid margin. Sessile (broad base) and Pedunculated (narrow base) types.
1. Squamous Cell Papilloma - skin tag
2. Simple excision at the base of the lesion
Flat, yellowish plaques most commonly in nasal/medial lid, may have Arcus - yellow halo. Occurs in middle age-older patients, greater in females. Usually bilateral, associated with hyperlipidemias - High cholesterol, triglycerides, etc.
2. Cardiovascular work up, education, reasurance, refer for excision if a cosmetic concern
Lesions caused by pox virus - raised white pink nodule with unlilication - direct contact or fomites in children or sexual transmission in adults. Single or multiple - up to 20, more in AIDS patients, may produce pseudo-follicular conjunctivitis.
1. Molluscum Contagiosum
2. self remission within a year, incision/excision, cryosurgery, electrodesication. More challenging to treat in AIDS patients
Umbilicated Skin lesion with keratin plug presenting as a solitary rapidly growing nodule on sun-exposed areas of middle aged and older individuals, originates from neck of hair follicle. Pre-cancerous or variant of squamous cell carcinoma. 6% become SCC if untreated.
2. Prompt action of complete excision, radiotherapy and intralesion 5-FU
Overgrowth of melanotic cells, occurs in patients with FAIR SKIN, common on eyelid and margin, Junctional, Compound, or Intradermal types
2. Type occurring in childhood, small flat tan macules, nest cells in epidermis junction with dermis, spread is gradual and radial
3. Type occurring at older age, doesnt increase in diameter, becomes more elevated and more pigmented
4. Type with total migration into dermis, becomes dome shaped, pedunculated, or papillomatous, is less pigmented.
6. When is it suspicious
1. Melanotic Nevus
2. Junctional Melanotic Nevus
3. Compound Melanotic Nevus
4. Intradermal Melanotic Nevus
5. Removal not required unless for cosmesis, mechanical irritation/lid function, suspicious malignancy
6. irregular growth / loss of pigment - rarely can become malignant if junctional or compound
Scaly atrophic patch of skin, keratin overgrowth on skin. Flat, light gray/dark brown dry lesion. Most commponly in middle age patients and older of fair skin - sun exposure, considered pre-cancerous lesion - 10% becomes SSC in those with multiple lesions.
1. Actinic Keratosis
2. Photodocument, measure, draw, refer to dermatology for biopsy if suspicious, refer for excision
Most common malignancy of eyelid. White Male older patients with long hx of sun exposure, hx or fam hx of cancer. Rarely metastisizes. Early - no umbilication - Late - umbilication with pearly borders, can result in loss of lid function.
3. Type of surgery
1. Basal Cell Carcinoma
2. Excision w. reconstruction. complete removal with minimal collateral damage.
3. Mohs surgery - treatment of choice - micrographic surgery - other treatments - cryotherapy, electrodessication, laser ablation
Malignant tumor, high risk of metastasis, Fair skin, elderly, male, UV exposure, arising from keratinized squamous cell layer of the epidermis and resulting in separation of the corneum stratum, Second most common eye lid malignancy, far less common than BCC, Actinic keratosis is a precursor, raised, crusted plaques of keratin, progress rapidly and destroy tissue. More common on lower lid
1. Squamous Cell Carcinoma
2. excision w. reconstruction, Mohs surgery, Radiation
Highly malignant neoplasm that arises from the meibomian glands, Zeis glands, and sebaceous glands of caruncle and brow. Aggressive tumor with high recurrence, high potential for metastasis, and notable mortility rate. 5% of all eyelid cancers. More oftlen in women, 60 y/o, upper eyelid in 2/3 cases. Firm yellow nodule resembling chalazion, can look a variety of ways, plaque-like thickening of tarsal plate - unilateral, recurrent, resistant : RED FLAG.
2. Unique histology feature- cell appearance
1. Sebaceous Cell Carcinoma
2. Foamy Cells
3. Wide surgical excision - Mohs not as successful due to spread possibility, Radiation
Cutaneous skin lesion caused by invasive proliferation of malignant melanocytes. Nodular type is most common affecting of eyelids - 1% of eyelid malignancy. causes 2/3 of all tumor-related deaths from cutaneous cancers. Watch for changing cutaneous moles, excessive sun exposure/sensitivity, family hx, age, caucasions.
2. ABCDE meaning
1. Malignant Melanoma
2. Asymmetry, Border, Color, Diameter, Evolution
3. Wide surgical excision with 1 cm of skin margins - 1 cm of healthy tissue
Neoplasm that may affect the cutaneous or mucosal surfaces of the eyelids. Occurs in 25-30% of AIDS patients. Viral origin. Highly vascular, purple/red nodules on cutaneous aspect of eyelids and caruncle or on conjunctiva.
1. Kaposi's Sarcoma
2. Cryotherapy, radiation, excision, chemotherapy
Common congenital lesions that posess little growth potential. Contains both dermal and epithelial elements that are not normally found in the conjunctiva. Includes solid limbal dermoid, dermolipoma, and complex type
Compact, pale yellow growths that typically occur unilaterally at the inferotemporal limbus. superficial with minimal involvement of cornea and sclera. Histologic examination reveals a thick collagenous lesion containing hair, sweat glands, fat, sebaceous glands, bone tissue.
1. Solid Limbal Dermoids
2. Excision and reconstruction with corneal penetration
Choristoma with Less density than solid Dermolipoma and contains more ADIPOSE (fatty) tissue, TRUE CHORISTOMAS - FATTY TISSUE usually not found anterior to the orbital septum. Superior temporal bulbar conjunctiva b/w SR and LR insertion most common.
2. Surgery not required since the extension of the growth does not limit function, restricted to partial resection to anterior portion of tumor
Syndrome - oculoauriculovertebral dysplasia - bilateral limbal dermoids or dermolipomas, unilateral coloboma (congenital malformation) of upper lid and aniridia. Preauricular skin tags instead of ears, hypoplasia of facial bones, vertebral anomalies.