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Ocular Disease > Ocular Disease: Lecture 6: Eyelids > Flashcards

Ocular Disease: Lecture 6: Eyelids Flashcards

1
Q

What are the 7 Malignant Tumors we went over in class?

A
  1. Basal Cell Carcinoma
  2. Squamous Cell Carcinoma
  3. Keratoacanthoma
  4. Sebaceous Gland Carcinoma
  5. Lentingo Maligna
  6. Merkel Cell Carcinoma
  7. Kaposi Sarcoma
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2
Q

Eyelids: Malignant Tumors: Basal Cell Carcinoma

  1. How common of a human malignancy is it?
  2. How common is it as a Malignant Eyelid Tumor?
  3. Who does it affect more?
  4. 3 Major Risk Factors?
  5. % that are in the head and neck?
A
  1. Most common
  2. Most common (>90%)
  3. Males
  4. a. Chronic Sun Exposure
    b. Fair Skin
    c. Inability to Tan
  5. 90%; (10% are Eyelid)
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3
Q

Eyelids: Malignant Tumors: Basal Cell Carcinoma

Characteristics

  1. How fast does it grow?
  2. Is it invasive?
  3. Metastatic?
  4. What else?
  5. Prevalence?
A
  1. Slow growing
  2. Locally
  3. Rarely (greater risk if LARGER than 5 cm, and make sure to PALPATE LYMPH NODES!!)
  4. Madarosis
  5. a. Lower Lid
    b. Medial Canthus
    c. Upper Lid
    d. Lateral Canthus
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4
Q

Eyelids: Malignant Tumors: Basal Cell Carcinoma

Clinical Types

  1. 4 Major clinical Types?
A
  1. Nodular
  2. Noduloulcerative (rodent Ulcer)
  3. Sclerosing (Morphoeic)
  4. Other: (Cystic, Adenoid, Pigmented)
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5
Q

Eyelids: Malignant Tumors: Basal Cell Carcinoma

Nodular

  1. What does it look like?
  2. What is seen on it?
  3. Growth rate?
  4. May develop what?
A
  1. Shiny Firm Pearly Nodule
  2. Small, dilated surface Vessels
  3. Initially it’s very slow growing
  4. May develop an Ulcer
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6
Q

Eyelids: Malignant Tumors: Basal Cell Carcinoma

Noduloulcerative

  1. AKA?
  2. What is seen w/in the Nodule?
  3. What does the border look like?
  4. What do we see at the margins?
A
  1. Rodent Ulcer
  2. A Central Ulcer
  3. It will be raised and seem to “Roll Over”
  4. Dilated Vessels will be seen at the Margin
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7
Q

Eyelids: Malignant Tumors: Basal Cell Carcinoma

Sclerosing

  1. Form type?
  2. How common?
  3. Infiltration occurs how and where?
  4. What does it form?
  5. Margins are difficult to what?
  6. Looks like what condition?
A
  1. Morpheaform
  2. Less Common
  3. Lateral Infiltration beneath the Epidermis
  4. A Plaque
  5. They are difficult to Delineate
  6. Looks like Blepharitis
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8
Q

Eyelids: Malignant Tumors: Basal Cell Carcinoma

Typical Presentation

  1. What does it first show up as?
  2. What will the patient report about it?
  3. How fast does it increase in size?
  4. May report what problem?
A
  1. A “lump” that doesn’t go away
  2. That it’s been there a LONG TIME (up to 4 years)
  3. VERY SLOW INCREASE in size
  4. A small wound that won’t heal
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9
Q

Eyelids: Malignant Tumors: Basal Cell Carcinoma

Treatment

  1. What is done first?
  2. Canthal Tumors require what to be done?
  3. Finally, what 2 things do we need to tell them/do?
A
  1. Complete Excision and Biopsy (Rarely Radiation and Cryotherapy)
  2. Orbital CT
  3. Referral to Oncologist for Systemic work up and tell them to AVOID FURTHER SUN DAMAGE!!
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10
Q

Eyelids: Malignant Tumors: Basal Cell Carcinoma

Follow Up

  1. When after treatment?
  2. After that?
A
  1. Close follow ups for 3-6 months by dermatology

2. Annual Exam to monitor for recurrence

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11
Q

Eyelids: Malignant Tumors: Squamous Cell Carcinoma

  1. How common is it?
  2. Where is it most commonly seen?
  3. Who does it affect the most (3)?
  4. When is there a HIGHER INCIDENCE of this?
  5. Possible link to what STD?
A
  1. Less common than BCC (less than 10% of eyelid malignancies)
  2. On Lower lid and Lid Margin
  3. Elderly Patients w/fair complexion and those with a HIstory of Chronic Sun Exposure
  4. In patients who are Immune Compromised
  5. To HPV
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12
Q

Eyelids: Malignant Tumors: Squamous Cell Carcinoma

  1. More Aggressive than what?
    a. Metastatic in what % of cases?
    b. Where is it possible for it to metastasize?
  2. Why is diagnosis difficult?
A
  1. Than BCC
    a. 20%
    b. To Intracranial Space Via Orbit is Possible.
  2. May underlie a Benign Lesion (Actinic Keratosis and Cutaneous HORN)
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13
Q

Eyelids: Malignant Tumors: Squamous Cell Carcinoma

Clinical Variation

  1. Varies: 3 points to think about?
  2. 3 Clinical Types?
A
  1. a. Flat or Slightly Elevated Plaque
    b. May be Scaly or Ulcerated
    c. Often Arises from Actinic KERATOSIS
  2. a. Nodular
    b. Ulcerating
    c. Cutaneous Horn
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14
Q

Eyelids: Malignant Tumors: Squamous Cell Carcinoma

Clinical Types

  1. Nodular
    a. What does it look like?
    b. Type of Nodule?
  2. Ulcerating
    a. Base looks like what?
    b. What about the borders?
  3. Cutaneous Horn
    a. What may be present underneath it?
A
  1. a. Crusting erosions and cracks/fissures
    b. Hyperkeratotic Nodule
  2. a. Red
    b. Sharply defined borders
  3. a. Invasive SCC may be present
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15
Q

Eyelids: Malignant Tumors: Squamous Cell Carcinoma

Treatment

  1. First thing to do?
  2. 2 other possible things that can be done?
  3. What else?
A
  1. Excision and Biopsy (wider surgical margin than BCC)
  2. Adjunctive radiation, cryo or chemo therapy (or combo of them)
  3. Post-septal involvement (exenteration)
    * Referral to oncologist for a systemic work up
    * Avoid further sun damage
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16
Q

Eyelids: Malignant Tumors: Keratoacanthoma

  1. How common is it?
  2. How fast does it grow?
  3. Seen in whom?
  4. Where do we normally see it on the body?
  5. Who is affected more?
A
  1. Rare
  2. Rapidly growing lesion
  3. Elderly Adults (fair skinned; chronic sun exposure)
  4. Sun exposed areas
  5. Immune compromised = higher prevalence. Possibly a spectrum of SCC
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17
Q

Eyelids: Malignant Tumors: Keratoacanthoma

Clinical Presentation

  1. What does it look like
    a. Normally see where on the eye?
  2. How fast will it increase in size?
  3. When does growth normally stop?
  4. Spontaneous what?
  5. What happens in about 1 year?
A
  1. Pink, rapidly growing, hyperkerototic lesions
    a. Lower Lid frequently
  2. Double or triple size in a few weeks
  3. in about 2-3 months
  4. Spontaneous involution (keratin fille Crater)
  5. Complete Involution (significant scar)
18
Q

Eyelids: Malignant Tumors: Keratoacanthoma

Treatment

  1. What is normally done?
A
  1. Complete surgical excision
    * hard to differentiate from SCC dictates that surgical intervention should be considered
    * Tx may improve cosmetic outcome
19
Q

Eyelids: Malignant Tumors: Sebaceous Gland Carcinoma

  1. How common is it?
  2. Growth rate?
  3. Generally looks like what?
  4. Seen in whom?
  5. Who does it affect more?
  6. More common location on the eye?
A
  1. Very RARE
  2. Slow Growing
  3. Hard Yellowish Lesion (No characteristic Clinical appearance)
  4. Elderly Patients (5th to 7th decade)
  5. Females
  6. on the UPPER Lid. (simultaneously upper and lower lid 5% of the time)
20
Q

Eyelids: Malignant Tumors: Sebaceous Gland Carcinoma

  1. What does it arise from?
    a. So why is it found more often on the upper lid?
  2. Occasionally it comes from what 2 things?
A
  1. Meibomian Glands
    a. Cuz there are more glands there
  2. a. Glands of Zeis
    b. Sebaceous Glands of Caruncle
21
Q

Eyelids: Malignant Tumors: Sebaceous Gland Carcinoma

  1. Diagnosis is hard. Early stage resembles what 2 things?
  2. Cardinal Clinical Signs? (4)
A
  1. a. Chronic Blepharitis
    b. Recurrent Chalazion
  2. a. Madarosis
    b. Marginal Inflammation
    c. Poliosis
    d. Thickened Red Lid Margin
22
Q

Eyelids: Malignant Tumors: Sebaceous Gland Carcinoma

  1. What type of metastasis is possible? (2)
  2. What can happen to the Orbit?
A
  1. Regional or Systemic Metastasis is possible. (Lymphadenopathy)
  2. Orbital Extension is possible.
23
Q

Eyelids: Malignant Tumors: Sebaceous Gland Carcinoma

  1. Prognosis is worse if the following 3 things are seen:
  2. Prognosis is better if…? (1)
A
  1. a. On both lids (>80% mortality)

b. Size of lesion 10mm or greater
* >20mm = 60% mortality

c. Symptoms >6months –> 35% mortality
2. if it Arises from Glands of Zeis..MAYBE??

24
Q

Eyelids: Malignant Tumors: Sebaceous Gland Carcinoma

  1. 3 Clinical Types
A
  1. Nodular
  2. Spreading
  3. Pagetoid
25
Q

Eyelids: Malignant Tumors: Sebaceous Gland Carcinoma

Nodular

  1. What is it?
  2. May be YELLOWISH. Why?
  3. What does it look like?
A
  1. Hard Nodule w/in Upper Tarsal Plate
  2. Due to lipids w/in the Lesion
  3. Like a Chalazion
26
Q

Eyelids: Malignant Tumors: Sebaceous Gland Carcinoma

Spreading

  1. What does it infiltrate?
  2. What happens to the Lid Margin?
  3. What 2 things are possible?
  4. What does it resemble?
  5. May be what?
A
  1. The Dermis
  2. Thickens
  3. Madarosis and Poliosis
  4. Chronic Blepharitis
  5. non-contiguous
27
Q

Eyelids: Malignant Tumors: Sebaceous Gland Carcinoma

Pagetoid

  1. May resemble what condition?
  2. What does it spread to?
A
  1. an Inflammatory Condition

2. Bulbar Conj, Fornix, or Palpebral

28
Q

Eyelids: Malignant Tumors: Sebaceous Gland Carcinoma

Treatment

  1. Type of biopsy?
  2. What other biopsy can be done?
  3. Finally, what 3 treatments are possible?
A
  1. Full thickness Biopsy
  2. Map Biopsies (Determine FULL EXTENT of LESION)
  3. a. Exenteration may be necessary
    b. Palliative Radiation
    c. Total Resection
29
Q

Eyelids: Malignant Tumors: Melanoma

  1. Type of tumor?
  2. How common is it?
  3. Type of Lesion?
  4. Is it Metastatic?
A
  1. Most LETHAL PRIMARY SKIN TUMOR
  2. RARE (<1% of all eyelid malignancies)
  3. Pigmented Plaque or Lesion (may be non-pigmented…50%)
  4. Highly. Early detection and treatment is critical.
30
Q

Eyelids: Malignant Tumors: Melanoma

  1. Suspicious Findings? (ABCDEFG)
A

Assymmetry

Border (Irregular)

Color (Inconsistent)

Diameter (> 6mm)

Evolving or changing

Elevated

Firm

Growth

31
Q

Eyelids: Malignant Tumors: Melanoma

Suspicious Findings

  1. Other? (4)
A
  1. Itching
  2. Oozing
  3. Pain
  4. Scaliness
32
Q

Eyelids: Malignant Tumors: Melanoma

  1. Three Histological Types (NSL)
A
  1. Nodular
  2. Superficial Spreading
  3. Lentigo Maligna
33
Q

Eyelids: Malignant Tumors: Melanoma

Nodular

  1. How common on eyelids?
  2. Nodule color?
  3. Surrounded by what?
  4. How aggressive is it?
A
  1. VERY RARE
  2. Bluish Black Nodule
  3. Surrounded by Normal Skin
  4. VERY AGGRESSIVE (Worst Prognosis)
34
Q

Eyelids: Malignant Tumors: Melanoma

Superficial Spreading

  1. How common is this form?
  2. Onset time?
  3. What does it look like?
  4. Pigment color normally?
  5. Quickly develops into what?
A
  1. Most COMMON Form (80%)
  2. 20-60 years of age
  3. Plaque w/an Irregular Border
  4. Often Variable and Inconsistent
  5. into a Raised Nodule
35
Q

Eyelids: Malignant Tumors: Melanoma

Lentigo Maligna

  1. AKA?
  2. % of melanoma cases?
  3. Associated with what?
  4. Seen in whom?
  5. What is it?
  6. How does it enlarge?
A
  1. Hutchinsons Freckle
  2. 10%
  3. Sun damaged Skin
  4. Elderly Patients
  5. Flat tan-brown plaque w/irregular borders
  6. Enlarges Radially!
36
Q

Eyelids: Malignant Tumors: Melanoma

Treatment

  1. What is it?
    a. May include what?
A
  1. Wide Excision

a. May include Local Lymph Node Removal

37
Q

Eyelids: Malignant Tumors: Merkel Cell Carcinoma

  1. How common is it?
  2. Growth rate of lesion?
  3. Where is it usually found?
  4. Seen in whom?
  5. How malignant are they?
A
  1. RARE
  2. Rapidly growing solitary lesion
  3. On Head and Neck. (20 cases of eyelid tumor Since 1983); Upper Lid Predilection
  4. Elderly Patients
  5. Highly; 50% of patients have metastatic spread at diagnosis
38
Q

Eyelids: Malignant Tumors: Merkel Cell Carcinoma

Presentation

  1. Type of Nodule?
  2. May have what on the surface of it?
  3. Who is it usually seen in? (race)
  4. Metastasis?
  5. Prognosis?
A
  1. Non Tender Violaceous Nodule
  2. Telangiectatic Vessels on the Surface
  3. Caucasians
  4. to Local and Distal Lymph Nodes is Common
  5. Poor. >65% mortality if local spread.
39
Q

Eyelids: Malignant Tumors: Merkel Cell Carcinoma

Treatment

  1. What do they tend to do? (3)
A
  1. Complete Excision
  2. Lymph Node Resection
  3. Chemo/Radiation Therapy Likely.
40
Q

Eyelids: Malignant Tumors: Kaposi Sarcoma

  1. What is it?
  2. What’s it normally associated with?
  3. Who does it occur in independently?
  4. Malignancy?
A
  1. Vascular Tumor
  2. AIDS
  3. In African and Mediterranean Descent (Rarely)
  4. Very malignant. esp when associate w/immunocompromised conditions
41
Q

Eyelids: Malignant Tumors: Kaposi Sarcoma

Presentation

  1. What does it look like?
  2. May be found in what 4 places?
  3. Treatment? (2)
A
  1. Pink or Red to Violet Lesion
  2. Conjunctive, Eyelids, Face, Mouth
  3. a. Excision
    b. Cryo/Radio/Chemo/Immuno therapy

Ocular Disease (11 decks)

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