TUMOURS OF EYELIDSDr NIKITA JAISWALPG RESIDENT

GLOSSARY: INTRODUCTION

ANATOMICAL CONSIDERATIONS

CLASSIFICATION

MANAGEMENT

ANATOMICAL CONSIDERATIONS:

EPIDERMIS

DERMIS

HYPODERMIS/ADIPOSE TISSUE

TUMOUR: A swelling of a part of a body generally without inflammation caused by

an abnormal growth of tissue..

Benign Malignant

Benign tumors: Epithelial tumors Melanocytic tumors Adnexal cystic lesions Sweat gland origin Hair follicle origin Miscellaneous lesions

Epithelial: Squamous papilloma: aka fibroepithelial

polyp,acrochordon,skin tag Appearance: they can be pedunculated & sessile. Histopathology: fibrovascular core &

hyperkeratosis of overlying epidermis. t/t : simple excision.

SEBORRHEIC KERATOSIS:-aka sebaceous wartApp—pigmented,greasy,stuck on appearance,small keratin plugs.Histo:horn cysts,hyperkeratosist/t: shave incision, a <3mm can be treated by cryotherapy.Leser-Trélat sign

KERATOCANTHOMA : a solitary,rapidly growing nodule on sun exposed arecenter crater filled keratin & rolled out margins

They gradual resolves on their own with minimal scarring.

If multiple then suggestive of

muir-torre syndrome or any other

internal malignancy.

CONGENITAL

MELANOCYTIC TUMORS

derived from nevocytes PRESENT AT BIRTH & PRESENTS

WITH HAIR KISSING NEVUS- cause is nevocyte

migration before seperation of lids Only 5% changes to malignancy…

Acquired:- Junctional nevus:arise in childhood & typically begin as a

lightly pigmented, nevocytes present in at the lid margin or elsewhere.

Cells migrate to dermis—thickness+pigmentation=compound nevus

EPIDERMIS:--1)LENTIGO SIMPLEX: small, brown macules. may be solitary/multiple-associated with perioral lesions

“git” polyps (peutz-jeghers syndrome)HISTO:-hyperpigmentation along basal layer of epidermis.

SOLAR LENTIGO:-brownish macules found over sun exposed area Slowly increases in size

Freckles: a brown macule “increased melanin in the epidermal basal layer”.

ADNEXAL CYSTIC LESIONS:

Epidermal inclusion cyst:small,solitary,slow growing in

dermis/subcut tissues. Histo: cyst lined by stratified squm.

epithelium.T/t : complete excision

Pilar(sebaceous)cyst: these have a punctum, it contains keratin which

turns into hair keratin.

Milia:multiple,tiny pin head sized,white lesions on the eyelids, nose & cheek

1’- arise spontaneously2’-after dermabrasion or trauma.

Histo: dilated keratin filled hair follicle along with atrophy.

Apocrine hidrocystoma: cystic nodule,bluish May be solitary or multipleArises from gland of moll

Histo:cyst lined by a double layer of cells,show bulbous end projecting into the lumen

SWEAT GLAND TUMOUR: SYRINGOMA:small,multiple skin coloured papules usually on the

eyelids & cheeks of young females HISTO:the ducts are lined by a double row of cells & exhibits a comma

shaped extension which gives a tadpole appearance.

HAIR FOLLICLE ORIGIN TUMOR: Trichoepithelioma:-skin coloured papule,gradually increases in size,mimick BCC but

do not ulcerate A.D inheritance.

Trichofolliculoma:-solitary small nodule with a central depression, multiple white hairs are seen to sprout from the center.

Trichilemmoma:- small nodular lesion which may show surface crusting or ulceration, mimick BCC

Pts are at risk of breast & thyroid carcinomas if they are in multiples.

Pilomatixoma:appears as a pink or purple subcut mass in the brow or upper lid of children,it resembles a dermoid cyst,lesion is mobile & firm or gritty.

Irregular epithelial

islands,calcification is present.

Nevus sebaceous(of jadassohn):nevi appear as yellowish, raised plaque like linear lesions on face,neck,scalp or trunk

Localized alopecia at the site of involvement Can undergo malignant changes.

VASCULAR TUMORS: Capillary hemangioma: these are cutaneous,bright red nodular lesions with surface lobulations. Appears at few weeks after birth & grow till 6-12 months then regress by 3 yrs.

HISTO: plump endothelial cells with obliterated lumen

T/t: local intralesional steroid injection or larger lesions may be excised safely.

PORT WINE STAIN: Diffuse vascular malformation involves skin in the trigeminal nerve

distribution area. Pink to purple,flat diffuse,unilateral. Does not regress with age Triad of cutaneous,ocular & meningeal-sturge weber syndrome. Involvement of the upper lid has higher risk of association HISTO:shows dilated capillaries in the dermis without proliferation of

capillaries. T/t: laser induces lightening of the lesion.

MISCELLANEOUS

Xanthelasma:appears as soft, yellow,well defined plaques,medial aspect of lid,

HISTO:foamy, lipid laden histioctes around blood vessels.

t/t: sugical excision,lasers,trichloroacetic acid application.

Molluscum contagiosum: these are small,pearly or pink nodules which

becomes umbilicated,Increase in n.o in AIDS pt.

T/T:excision,curettage,chemical cautery.

MALIGNANT TUMORS

SIGNS OF MALIGNANCY: SLOW,PAINLESS GROWING LESION

ULCERATION,BLEEDING & CRUSTING

PIGMENTARY CHANGES DESTRUCTION OF NORMAL EYELID MARGIN

CENTRAL ULCERATION

LOSS OF VELLUS HAIR.

BASAL CELL CARCINOMA It is a malignant cutaneous tumor. BCC: these does not metastasize. Rodent ulcers:- it invades tissue extensively.

RISK FACTORS:-UV radiation,fair skin,unable to tan,exposure to arsenic. C/F:- avg age 60 yrs tumor often arises in the lower lid & medial canthus Morphological forms: nodular:shiny,firm,pearly nodule with small dilated vessels it grows 0.5 cm in 1-2 yrs nodulo-ulcerative:central ulceration,pearly raised rolled edges dilated & irreguar vessels “it erodes”. morpheaform:it infiltrates laterally beneath the epidermis as an indurated plaque,the margins are difficult to delineate.

HISTO:-cells proliferate downwards Exhibits palisading at the periphery of a tumour

lobule of cells.

SQUAMOUS CELL CARCINOMA: SCC arises in prickle layer. Second most common eyelid tumor Risk factors:uv rays,exposure to sunlight,immunosuppression,albinism,chronic skin

lesions C/F:-Nodular or plaque like lesions,ulceration,rolled,out edges,greyish white

keratinisation. Order of frequency:medial canthus—upper lid—lateral canthus.

HISTO:arises from epidermisAtypical epithelial cells with prominent

nuclei Well differentiated tumours show

“keratin pearls”

SEBACEOUS CARCINOMA: Arises from the sebaceous glands & is more common than BCC & SCC. C/F:-nodule on a eyelid, yellowish,loss of lashes Shows intraepithelial spread—’’pategoid spread” Mimic a lot like chalazia Shows lymphatic & hematogenous spread.

histology: -cells with pale foamy vacuolated lipid containing cytoplasm with hyperchromatic nuclei.

Malignant melanoma: Common in fair skinned C/F: eyelid masses which show pigmentation,ulcerates& bleeds. May be nodular,superficial spreading or maligna.

histology:atypical melanocytes within the dermis.

LENTIGO MALIGNA Melanoma in situ , intraepidermal melanoma & hutchinson freckle. Common in fair skinned people.

Signs: slowly expanding pigmented macule with an irregular border

Histo:intraepidermal prolif of melanocytes

replaces basal layer.

Merkel cell carcinoma Fast growing tumour affecting the elderly involving UL mostly Its rarity gives it a difficult diagnosis;

Histology: sheet of cells with scanty cytoplasm.

Kaposi sarcoma It’s a vascular tumour which typically effects AIDS patient Sign:a pink,red violet to brown lesion

Histo: proliferating spindle cells,vascular channels & inflammatory cells.

MANAGEMENT

It outlines: BIOPSY

SURGICAL EXCISION

RADIOTHERAPY

CRYOTHERAPY

BIOPSY: INCISIONAL: this can be through blade or biopsy punch used for

histological study.

EXCISIONAL: In this the whole lesion is removed & it is also seen in shave excision to remove shallow tumors confined to epidermis & een deeper to it.

SURGICAL EXCISION AIM: removal of the tumor along with clear margin. THE THREE SECTIONS TO BE CONSIDERED.

CONVENTION PARAFFIN-EMBEDDED

STANDARD FROZEN SECTION:HISTO examination of the margins to ensure they are tumor free.

No tumor--------eyelid reconstructed.

MOHS MICROGRAPHIC SURGERY:layered excision of the tumor they are examined frozen…….. useful for tumors growing diffusely This maximises total tumor removal & minimises healthy tissue sacrifice

RADIOTHERAPY CRYOTHERAPY

This is performed by killing the cancer cells by ionizing radiation

T/T by freezing skin lesions These include cryogens like

liquid nitrogen

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