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MALIGNANT EYELID TUMOURS

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

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  1. 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

  2. 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

  3. Frequency of location of basal cell carcinoma Lower lid - 70% Medial canthus - 15% Upper lid - 10% Lateral canthus - 5%

  4. Nodular basal cell carcinoma Early Advanced • Slow progression • Shiny, indurated nodule • May destroy large portion of eyelid • Surface vascularization

  5. Ulcerative basal cell carcinoma (rodent ulcer) Early Advanced Chronic ulceration Raised rolled edges and bleeding

  6. 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

  7. Histology of basal cell carcinoma Cell nests in fibrous stroma Downgrowth from epidermis of small, dark atypical basal cells Peripheral palisading

  8. 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

  9. Histology of squamous cell carcinoma Prominent nuclei and abundant acidophilic cytoplasm Variable sized groups of atypical epithelial cells within dermis Keratin ‘pearl’

  10. 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

  11. Histology of meibomian gland carcinoma Cells stain positive for fat Cells contain foamy vacuolated cytoplasm and large hyperchromatic nuclei

  12. 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

  13. 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

  14. Merkel cell carcinoma • Highly malignant with frequent metastases at presentation • Fast-growing, violaceous, well-demarcated nodule • Intact overlying skin • Predilection for upper eyelid

  15. 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

  16. 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

  17. 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

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