MALIGNANT EYELID TUMOURS 1. Basal cell carcinoma 2. Squamous cell carcinoma 3. Meibomian gland...
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MALIGNANT EYELID TUMOURS
1. Basal cell carcinoma
2. Squamous cell carcinoma
3. Meibomian gland carcinoma4. Melanoma
5. Kaposi sarcoma
6. Merkel cell carcinoma
7. Treatment
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Basal Cell Carcinoma - Important Facts
1. Most common human malignancy
2. Usually affects the elderly
3. Slow-growing, locally invasive
5. 90% occur on head and neck
6. Of these 10% involve eyelids
7. Accounts for 90% of eyelid malignancies
4. Does not metastasize
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Frequency of location of basal cell carcinoma
Lower lid - 70% Medial canthus - 15%
Upper lid - 10% Lateral canthus - 5%
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Nodular basal cell carcinomaEarly
• Shiny, indurated nodule
• Surface vascularization
• Slow progression
Advanced
• May destroy large portion of eyelid
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Ulcerative basal cell carcinoma(rodent ulcer)
Early
Chronic ulceration
Advanced
Raised rolled edges and bleeding
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Sclerosing basal cell carcinoma
• Indurated plaque with loss of lashes
Advanced
• Spreads radially beneath normal epidermis
Early
• May mimic chronic blepharitis • Margins impossible to delineate
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Histology of basal cell carcinoma
Downgrowth from epidermisof small, dark atypical basal cells
Peripheral palisading
Cell nests in fibrous stroma
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Squamous cell carcinoma
• Predilection for lower lid
• Hard, hyperkeratotic nodule
• Less common but more aggressive than BCC
• May develop crusting fissures
• May arise de novo or from actinic keratosis
Ulcerative
• No surface vascularization
• Red base• Borders sharply defined, indurated and elevated
Nodular
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Prominent nuclei and abundant acidophilic cytoplasm
Variable sized groups of atypical epithelial cells within dermis
Histology of squamous cell carcinoma
Keratin ‘pearl’
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Meibomian gland carcinoma
Spreading
Nodular
• Very rare aggressive tumour with 10% mortality• Predilection for upper lid
Hard nodule; maymimic a chalazion
Very large tumour
Diffuse thickening of lid margin and loss of lashes
Conjunctival invasion; maymimic chronic conjunctivitis
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Histology of meibomian gland carcinoma
Cells stain positive for fatCells contain foamy vacuolatedcytoplasm and large hyperchromatic nuclei
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Melanoma
From lentigo maligna (Hutchinson freckle)
Nodular
• Blue-black nodule with normal surrounding skin
• Plaque with irregular outline• Variable pigmentation
• Affects elderly• Slowly expanding pigmented macule• May be non-pigmented
Superficial spreading
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Kaposi sarcoma
Advanced Early
Pink, red-violet lesion
• Vascular tumour occurring in patients with AIDS• Usually associated with advanced disease• Very sensitive to radiotherapy
May ulcerate and bleed
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Merkel cell carcinoma
• Highly malignant with frequent metastases at presentation• Fast-growing, violaceous, well-demarcated nodule• Intact overlying skin• Predilection for upper eyelid
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Treatment Options
3. Cryotherapy
2. Radiotherapy• Small BCC not involving medial canthus
1. Surgical excision• Method of choice
• Small and superficial BCC irrespective of location
• Adjunct to surgery in selected cases
• Kaposi sarcoma
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Lower eyelid reconstruction following tumour excision
Mustarde cheek rotation flap for large defect
Tenzel flap for moderate defect
Direct closure of small defect
a b
a
b b
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Eyelid-sharing procedure
Reconstruction of posterior lamella
Extensive sclerosing BCC Total excision of lower lid Tarsoconjunctival flap
Reconstruction of anterior lamella with skin graft
Appearance after healing