BENIGN TUMORS

OF EYELID

-10M2368

CLASSIFICATION

BbBBRBBENIBRR BENIGN MALIGNANT PRE-MALIGNANT

BENIGN TUMORS:

I. PAPILLOMASII. XANTHELASMAIII. HEMANGIOMAIV. NEURFIBROMAV. KERATOACANTHOMAVI. NAEVIVII. DERMOID CYST

PAPILLOMA Most common benign tumors arising from

the surface epithelium. Occurs in two forms >Squamous cell Papilloma >Basal cell Papilloma [ Seborrhoeic Keratosis]

SQUAMOUS CELL PAPILLOMA Outgrowth of fibrovascular connective tissue covered by

irregular keratinized stratified squamous epithelium No predilection to race or gender

Appearance Variable presentations “Skin tag” type: narrow base, pedunculated, skin colored Board base with “raspberry like” appearance Differentiate from viral wart (human papilloma virus)

Management Removed by excision

PEDUNCULATED

SESSILE

BASAL CELL PAPILLOMA Expansion of the squamous epithelium stemming from

basal cell proliferation Common in the elderly Usually develop on the head, neck, or trunk

Appearance Round “coin-like” lesion with “stuck-on” appearance Up to 2.5 cm diameter Slightly raised and crusty; surface is friable, verrucous

and slightly pigmented (Tan to dark brown in color) Variety of textures: granular to velvety

Management No treatment required except for cosmetic reasons or if

they become irritated Removed by excision

XANTHELASMAAggregation of lipid filled macrophages at the level of the dermis Common and frequently bilateral. Middle aged and the elderly. Associated with elevated cholesterol especially when

occurring in younger individuals with Arcus senilis.

Appearance Yellowish subcutaneous plaque Usually on the medial portion of the eyelids Often multiple

Management Removed for cosmetic reasons Usually excised with carbon dioxide or argon laser Recurrence suggests persistently elevated cholesterol

Appearance:

>Yellowish subcutaneous plaque

>Usually on the medial portion of the eyelids

>Often multiple

HEMANGIOMA

Hemangiomas of the lids are common tumors.

Occurs in three forms: 1. Capillary hemangioma. 2. Naevus flammeus(Port-wine stain). 3. Cavernous hemangioma.

CAPILLARY HEMANGIOMA Most common variety. Occurs at/shortly after birth and grows rapidly.

APPEARANCE: Superficial, bright red in colour (strawberry naevus) / deep bluish / violet in colour.

: consist of proliferating capillaries and endothelial cells. TREATMENT: Resolves spontaneously by the age of 7 yrs. Excision for small tumors. Intralesional steroid( Triamcinolone) Alternate day high dose steroid therapy & Superficial Radiotherapy.

Starts as small, red lesion,most frequently on upper lid

Blanches with pressure and swells on crying

NAEVUS FLAMMEUS• May occur commonly in Sturge-

Weber syndrome.( associated with port-wine stains of the face, glaucoma, seizures, mental retardation)

• Consists of dilated vascular channels

• Does not regress like capillary hemanigioma

• LASER TREATMENT:

CAVERNOUS HEMANGIOMA Occurs after first decade of

life

commonly present as solitary, unilateral lesions

Consists of large endothelium lined vascular channels

Does not show any regression

TREATMENT:

INVERTED FOLLICULAR KERATOSIS Rare and often rapid growing lesion arising from a hair

follicle Typically older males

Appearance Non pigmented papilloma at the lid margin Up to 1 cm diameter Histologically similar to basal cell papilloma, but

with deeper extension into the dermis

Management Deep excision Recurrence is common if not completely

removed

INVERTED FOLLICULAR KERATOSIS

NEUROFIBROMA Abnormal proliferation of Schwann cells, fibroblasts, and

axons Solitary lesions occur in adults 25% associated with neurofibromatosis-1 Children with neurofibromatosis-1 are affected by

diffuse lesions

Appearance Characteristic S shaped lesion Typically located on the upper lid

Management Solitary lesions removed by excision Diffuse lesions are more difficult to remove

KERATOACANTHOMA Rare and rapidly growing variant of actinic keratosis Higher occurrence in patients on immunosuppressive therapy following kidney transplants

Appearance Initially appears as a pink hyperkeratotic lesion usually on

the lower lid After a period of rapid growth, remains stable for

several months Then begins to involute and a keratin filled crater

often forms Complete involution can occur after a year leaving

a residual scar

Management Usually excised with cryotherapy or radiotherapy

MELANOCYTIC NEVUSTumor composed of cells derived from arrested epidermal melanocytes Acquired and congenital forms

TYPES: Junctional type occurs in the young Compound type occurs in middle age Intradermal type most common and occurs in the elderly

Management Removal for cosmetic reasons or if malignancy is

suspected Excision may need to be followed by reconstruction

depending on location and size

Junctional Nevus:: Uniform brown macule or plaque

Compound Nevus:Uniform, light to dark brown, raised papule

Intradermal Nevus:: Papillomatous with little to no pigment. Associated with dilated vessels and protruding lashes

DERMOID CYST A dermoid is an overgrowth of normal, non-

cancerous tissue in an abnormal location.  There are two main types: orbital dermoid is typically found in

association with the bones of the eye socket.

epibulbar dermoid is found on the surface of the eye, either at the junction of the cornea and sclera (limbal epibulbar dermoid) or posteriorly on the eye (posterior epibulbar dermoid or lipodermoid).

DERMOID CYST OF EYELID

PRE-MALIGNANT TUMORS

ACTINIC KERATOSIS XERODERMA PIGMENTOSA

DEFINITION: Slow growing keratinization of the epithelium from excessive sun exposure

May transform into squamous cell carcinoma Elderly individuals with lightly pigmented skin Rarely develops on the eyelid Common on the scalp, ears, forehead, and backs of

hands

Appearance Rough, dry, and scaly plaque that is flat or slightly

raised, distinct boarders Often multiple lesions in a single area that coalesce May be skin colored to dark brown

ACTINIC KERATOSIS

MANAGEMENT:

1.BIOPSY: DEFINITIVE DIAGNOSIS2.FROZEN (CRYOTHERAPY) OR EXCISED

XERODERMA PIGMENTOSA

Autosomal recessive disease Damage on exposure to sunlight Characterstic features Progressive cutaneous pigmentation Bird-like facies is typical. Predisposition to develop lid tumors

Thank you^_^