MALIGNANT EYELID TUMOURS
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MALIGNANT EYELID TUMOURS. 1. Basal cell carcinoma. 2. Squamous cell carcinoma. 3. Meibomian gland carcinoma. 4. Melanoma. 5. Kaposi sarcoma. 6. Merkel cell carcinoma 7. Treatment. Basal Cell Carcinoma - Important Facts. 1. Most common human malignancy.

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MALIGNANT EYELID TUMOURS

1. Basal cell carcinoma

2. Squamous cell carcinoma

3. Meibomian gland carcinoma

4. 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

4. Does not metastasize

5. 90% occur on head and neck

6. Of these 10% involve eyelids

7. Accounts for 90% of eyelid malignancies


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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 carcinoma

Early

Advanced

  • Slow progression

  • Shiny, indurated nodule

  • May destroy large portion of eyelid

  • Surface vascularization


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Ulcerative basal cell carcinoma

(rodent ulcer)

Early

Advanced

Chronic ulceration

Raised rolled edges and bleeding


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Sclerosing basal cell carcinoma

Advanced

Early

  • Spreads radially beneath normal

  • epidermis

  • Indurated plaque with loss of lashes

  • May mimic chronic blepharitis

  • Margins impossible to delineate


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Histology of basal cell carcinoma

Cell nests in fibrous stroma

Downgrowth from epidermis

of small, dark atypical basal cells

Peripheral palisading


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Squamous cell carcinoma

  • Less common but more aggressive than BCC

  • May arise de novo or from actinic keratosis

  • Predilection for lower lid

Nodular

Ulcerative

  • Hard, hyperkeratotic nodule

  • Red base

  • May develop crusting fissures

  • Borders sharply defined, indurated

  • and elevated

  • No surface vascularization


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Histology of squamous cell carcinoma

Prominent nuclei and

abundant acidophilic

cytoplasm

Variable sized groups of atypical

epithelial cells within dermis

Keratin ‘pearl’


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Meibomian gland carcinoma

  • Very rare aggressive tumour with 10% mortality

  • Predilection for upper lid

Nodular

Hard nodule; may

mimic a chalazion

Very large tumour

Spreading

Diffuse thickening of lid

margin and loss of lashes

Conjunctival invasion; may

mimic chronic conjunctivitis


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Histology of meibomian gland carcinoma

Cells stain positive for fat

Cells contain foamy vacuolated

cytoplasm and large

hyperchromatic nuclei


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Melanoma

Nodular

Superficial spreading

From lentigo maligna

(Hutchinson freckle)

  • Plaque with irregular

  • outline

  • Affects elderly

  • Blue-black nodule with

  • normal surrounding skin

  • Slowly expanding

  • pigmented macule

  • May be non-pigmented

  • Variable pigmentation


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Kaposi sarcoma

  • Vascular tumour occurring in patients with AIDS

  • Usually associated with advanced disease

  • Very sensitive to radiotherapy

Early

Advanced

May ulcerate and bleed

Pink, red-violet lesion


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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

1. Surgical excision

  • Method of choice

2. Radiotherapy

  • Small BCC not involving medial

  • canthus

  • Kaposi sarcoma

3. Cryotherapy

  • Small and superficial BCC

  • irrespective of location

  • Adjunct to surgery in selected cases


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Lower eyelid reconstruction

following tumour excision

a

b

Direct closure of small defect

a

b

b

Mustarde cheek rotation

flap for large defect

Tenzel flap for

moderate defect


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Eyelid-sharing procedure

Total excision of lower lid

Tarsoconjunctival flap

Extensive sclerosing BCC

Appearance after healing

Reconstruction of

posterior lamella

Reconstruction of anterior

lamella with skin graft