Ocular Oncology

Question 1

What is basal cell carcinoma?

Answer 1

The most common type non melanomas skin cancer

Question 2

What is the incidence of BCC?

Answer 2

3 million worldwide

Question 3

What causes BCC?

Answer 3

UV exposure

Question 4

What the risk factor for BCC?

Answer 4

Fair skin
Sun exposure 
Previous BCC
Rarely hereditary 
Elderly

Question 5

What are the different BCC subtypes?

Answer 5

1. Nodular
2. Superficial
3. Morphoic/infiltrative
4. Pigmented

Question 6

What are the signs to look out for in BCC?

Answer 6

1. Rolled pearly edges
2. Loss of lashes
3. Ectropian/entropic
4. Misdirected lashes
5. Loss of normal lid margin
6. Medial cantus popular location

Question 7

Which is the worst type of BCC?

Answer 7

Pigmented. Can be mistaken for melanoma

Question 8

What is the main treatment for BCC?

Answer 8

Surgical incision

Question 9

What other BCC treatments are there?

Answer 9

Radiotherapy
Cryotherapy
Topical

Question 10

Which treatment option for BCC gives a better cute rate?

Answer 10

Radiotherapy

Question 11

What is the management for BCC?

Answer 11

Non urgent referral, seen in 3/12

Question 12

What is another common non melanoma skin cancer?

Answer 12

Squamous cell carcinoma (SCC)

Question 13

Where can SCC progress from?

Answer 13

De novo (Anew)
Untx actinic keratosis
Bowens disease

Question 14

What is the cause of SCC?

Answer 14

Cumulative UV exposure
Immune suppression
Xerdema pigmentosa
Oculocutaneous albinism

Question 15

What are the signs of SCC?

Answer 15

Thick, rough scaly patches 
Bleed
Warts
Produces keratin 
Increase rapidly in size

Question 16

What big risk does SCC have?

Answer 16

Metastasize

Question 17

What are the risk factors for mets?

Answer 17

Sun exposed area
Size >2mm
Depth >4mm

Question 18

What is the treatment for SCC?

Answer 18

Excision and reconstruction

Question 19

What is the management for SCC?

Answer 19

Urgent referral to oculoplastics- 2/52 wait. If neglected can turn into BCC

Question 20

Name a type of malignant tumor found on the eyelid?

Answer 20

Sebaceous gland carcinoma

Question 21

What does SGC resemble?

Answer 21

Blepharitis

Question 22

Which glands are in question with SGC?

Answer 22

Glands of zeiss

Meibomian glands

Question 23

What are the signs of SGC?

Answer 23

Madarosis
Nodular
Yellow colour

Question 24

How is SGC managed?

Answer 24

Urgently referred to oculoplastics for excision- 2/52 wait

Question 25

Where does conjunctival melanoma arise from?

Answer 25

1. PAM (primary acquired melanosis) 2. Naevis 3. De novo

Question 26

What are the signs of conjunctival melanoma?

Answer 26

Raised mass Amelanotic, usually pigmented Feeder vessel

Question 27

Where can the conjunctival melanoma matestasize to?

Answer 27

Lymph nodes and brain

Question 28

Why is dry technique used in surgery for SGC?

Answer 28

As to not spread the melanoma cells. Could spread

Question 29

How is conjunctival melanoma managed?

Answer 29

Referred urgently= HES 2/52 wait

Question 30

What surgical intervention is used to tx conjunctival melanoma?

Answer 30

Surgical excision | Cryotherapy

Question 31

When does a conjunctival melanoma have a poor prognosis?

Answer 31

When its recurrent

Question 32

What's the key difference between PAM and a naevi?

Answer 32

PAM- Middle age | Naevi- 1st and 2nd decade

Question 33

What is a reassuring sign of a naevi?

Answer 33

Clear cysts

Question 34

If the naevi turned out to be a PAM, how would you know and what action would you take?

Answer 34

``` Documented growth Refer urgently (1/12) if hx suggests PAM ```

Question 35

Where is a uveal melanoma located?

Answer 35

Uveal tract- commonest primary intraocular malignancy

Question 36

What is the incidence of uveal melanoma?

Answer 36

5-7 mill population/yr

Question 37

Where is the main site of a uveal melanoma?

Answer 37

Choroid (65%) Ciliary body (30%) Iris (5%)

Question 38

What are the risk factors for iris melanoma?

Answer 38

Caucasian

Question 39

What are the signs of iris melanoma?

Answer 39

Circumscribed, diffuse or amelontic Deeply pigmented Hyperchromic heterochromia

Question 40

If an iris melanoma is suspected what action is taken?

Answer 40

Refer directly to HES

Question 41

What different posterior uveal melanomas are there?

Answer 41

Ciliary body melanoma Choroidal melanoma Choroidal naevi Intermediate melanocytic lesios (ILM)

Question 42

What sign in particular would indicate a ciliary body melanoma?

Answer 42

Mass in red reflex

Question 43

What other conditions that can followed by a ciliary body melanoma?

Answer 43

Cataracts Retinal detachment Lenti astigmatism

Question 44

What 4 sxs are present in a choroidal melanoma?

Answer 44

Asymptomatic Vision loss Metamorphopsia Photopsia

Question 45

What are the signs of choridal melanoma?

Answer 45

``` Elevated lesion Pigmented Ret detach Breach in BM Subret fluid ```

Question 46

How prevalent is a choroidal neavi?

Answer 46

Common prev of 5-10%

Question 47

What are the signs of choroidal neavi?

Answer 47

Slate grey Flat Ill defined border Surface druesen

Question 48

What type melanoma is not considered to be a melanoma

Answer 48

ILM intermediate melanocytic lesions has low malignant potential

Question 49

What is a common intraocular tumour especially in children?

Answer 49

Retinoblastoma

Question 50

What key signs are found in reinoastoma?

Answer 50

Leukocoria Strabismus 2nd glaucoma Iris neovasc Vit haemm Pseudohypopyon Orbital cellulitis

Question 51

What are the early presentation of retinoblastoma?

Answer 51

Question 52

What are the late and advanced signs of retinoblastoma?

Answer 52