Date post: | 26-Jun-2015 |
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TUMOURS OF TUMOURS OF THE LIDSTHE LIDS
Dr. Christina SamuelDr. Christina Samuel
Common benign tumors of Common benign tumors of the lids the lids
A. CystsA. Cysts Dermoid cyst Dermoid cyst Sebaceous cystSebaceous cyst Meibomian cyst Meibomian cyst B. Tumors B. Tumors - Naevus or mole - Naevus or mole - Papilloma - Papilloma - Hemangioma- Hemangioma- Neuro fibroma - Neuro fibroma - Granuloma - Granuloma - Warts - Warts - Xanthalosma - Xanthalosma - Molascum contagiasm - Molascum contagiasm
Dermoid Dermoid
Presents since birth and came grow Presents since birth and came grow in to a large size in to a large size
Typically found at the outer orbital Typically found at the outer orbital margin but may be else were also margin but may be else were also
The tumor is fixed to the underlying The tumor is fixed to the underlying bone – zygomatico temporal suturebone – zygomatico temporal suture
the skin our the tumour is freely the skin our the tumour is freely movable movable
Treatment Treatment
Surgical excision to be removed Surgical excision to be removed intact intact
Cauterization Cauterization
Sebaceous cyst Sebaceous cyst
It looks like a dermoid It looks like a dermoid
TThe differentiating features from the he differentiating features from the dermoiddermoid
The sebaceous cyst is not attached firmly to The sebaceous cyst is not attached firmly to the underlying structures. But freely movable the underlying structures. But freely movable
A pigmented point on the skin were the skin A pigmented point on the skin were the skin is adherent to the underlying cyst is adherent to the underlying cyst
Unlike a dermoid it can be present any were Unlike a dermoid it can be present any were in the lid and is commonly seen at the inner in the lid and is commonly seen at the inner port of the upper eye lid port of the upper eye lid
Naevous or mole Naevous or mole
Commonly seen at the muco Commonly seen at the muco cutaneous junction of the lid cutaneous junction of the lid
It may affect either the skin or It may affect either the skin or conjunctiva of the lid conjunctiva of the lid
It may undergo malignant It may undergo malignant transformation if untreated transformation if untreated
Neuro fibroma Neuro fibroma
Multiple pedunculated growth of Multiple pedunculated growth of varying may be seen on the skin of the varying may be seen on the skin of the lid lid
It may be seen on the eye lid as a part It may be seen on the eye lid as a part of generalised neuro fibrofibrometosis of generalised neuro fibrofibrometosis (Von reckling hausen’s diseases) (Von reckling hausen’s diseases)
It may cause mechanical ptosisIt may cause mechanical ptosis Small multiple tumor are distributed Small multiple tumor are distributed
along the hyper trophied nerves along the hyper trophied nerves
Papilloma (sqamous Papilloma (sqamous papilloma) papilloma)
It is the most common benign tumor of It is the most common benign tumor of the eye lid the eye lid
It affects patients older then 30 yrs due to It affects patients older then 30 yrs due to exposure to Ultra violet rays exposure to Ultra violet rays
It may present as a round multi lobular It may present as a round multi lobular lesion with a central vascular core lesion with a central vascular core
Treatment:Treatment: Electrocautery Electrocautery Chemical caterization Chemical caterization CoCo22 laser ablation laser ablation
Hemangioma Hemangioma
There are two types There are two types Capillary hemangioma Capillary hemangioma
Manifests as bright red or portwine Manifests as bright red or portwine spots – composed of dilated capillaries spots – composed of dilated capillaries
Cavernous hemagioma Cavernous hemagioma Manifests as large dilated and Manifests as large dilated and
anastomosing subcutaneous venous anastomosing subcutaneous venous channels with are blue in colour channels with are blue in colour
In general In general
Hemangiomas are found along the Hemangiomas are found along the distribution of first and second distribution of first and second divisions are the trigeminal nerve divisions are the trigeminal nerve
Hemangiomas of the lid is often Hemangiomas of the lid is often associated hemangioma of the associated hemangioma of the coroid, leptomeninges and coroid, leptomeninges and hydrophthalmos (Sturge-weber hydrophthalmos (Sturge-weber syndrome) syndrome)
Treatment Treatment
Small hemangioma – Spontaneous Small hemangioma – Spontaneous involution involution
Large hemangiomasLarge hemangiomas Intra lesion injection of a mixture of Intra lesion injection of a mixture of
40mg of triamcinolone acetonide & 6mg 40mg of triamcinolone acetonide & 6mg of beta methasone sodium phosphate of beta methasone sodium phosphate
Systemic Corticosteroids Systemic Corticosteroids RadiotheraphyRadiotheraphy Surgical excision Surgical excision
Xanthelasma Xanthelasma
It affects elderly woman It affects elderly woman Associated with diabetics and hyper Associated with diabetics and hyper
Cholestero laemia Cholestero laemia It appears as slightly raised yellow It appears as slightly raised yellow
wrinkled plaques near the inner cantus wrinkled plaques near the inner cantus
Treatment:Treatment: Surgical excision Surgical excision Cryotheraphy Cryotheraphy
Malignant tumors of the Malignant tumors of the eye lideye lid
There are three types There are three types 1. Carcinomas1. Carcinomas 2. Sarcomas 2. Sarcomas 3. Malignant melanoma 3. Malignant melanoma
Carcinomas Carcinomas
1. Basal cell carcinomas 1. Basal cell carcinomas
2. Squamous cell carcinoma 2. Squamous cell carcinoma
3. Sebaceous cell carcinoma 3. Sebaceous cell carcinoma
Sarcomas Sarcomas
1. Kaposi sarcoma – in AIDS patients 1. Kaposi sarcoma – in AIDS patients
2. Reticular tumors 2. Reticular tumors
- Lymphoma - Lymphoma
- Lympho sarcoma - Lympho sarcoma
Basal cell carcinoma Basal cell carcinoma (rodent ulcer) (rodent ulcer)
It is the commonest malignant epithelial It is the commonest malignant epithelial growth of the eye lid (90%)growth of the eye lid (90%)
Risk factors Risk factors People with fair skin People with fair skin Chronic exposure to sunlightChronic exposure to sunlight
Rarely occurs before 40yrs of age Rarely occurs before 40yrs of age Shows predilection for the medial cantus Shows predilection for the medial cantus
in the lower lid in the lower lid It comments as a small nodule which It comments as a small nodule which
ulcerates in its central part ulcerates in its central part
Ulcers Ulcers
Edges are raised an indurate Edges are raised an indurate Spreads very slowly, extending under Spreads very slowly, extending under
the skin in all directions and the skin in all directions and penetrating deeply like a Rodent penetrating deeply like a Rodent (hence the name) (hence the name)
The surrounding structures are The surrounding structures are gradually destroyed an the lids, orbit gradually destroyed an the lids, orbit and the bones are invadedand the bones are invaded
The growth is locally malignant, The growth is locally malignant, lymphnodes are not affected lymphnodes are not affected
CLINICAL TYPES:CLINICAL TYPES:
NODULARNODULAR ULCERATIVEULCERATIVE SCLEROSINGSCLEROSING
NODULAR TYPENODULAR TYPE
Shiny ,translucent,firm raised Shiny ,translucent,firm raised indurated nodule with small dilated indurated nodule with small dilated blood vessels on its surfaceblood vessels on its surface
Initially growth is slow but the Initially growth is slow but the subsequent growth is faster subsequent growth is faster
ULCERATIVE TYPEULCERATIVE TYPE
Raised lesion with rolled borders Raised lesion with rolled borders and an ulcerated centreand an ulcerated centre
Dilated blood vessels may course Dilated blood vessels may course from the surfacefrom the surface
Bleeding is common after relatively Bleeding is common after relatively trivial trauma.trivial trauma.
SCLEROSING TYPESCLEROSING TYPE
Originates in the epidermis but soon Originates in the epidermis but soon spreads to the dermis spreads to the dermis
Occurs as a flat indurated plaque,not Occurs as a flat indurated plaque,not associated with telangiectatic blood associated with telangiectatic blood vessels of the surfacevessels of the surface
Occasionally simulate chronic Occasionally simulate chronic blepharitisblepharitis
treatmenttreatment
Most small BCC require excision Most small BCC require excision with a 3 mm excision of the tissue with a 3 mm excision of the tissue which look clinically normalwhich look clinically normal
Standard frozen section involves per Standard frozen section involves per operative examination of tissue at operative examination of tissue at the margin of the excised tissuethe margin of the excised tissue
SQUAMOUS CELL SQUAMOUS CELL CARCINOMACARCINOMA
It is much less common but It is much less common but potentially aggressive tumour than potentially aggressive tumour than BCC with metastasis to the regional BCC with metastasis to the regional lymphnodes lymphnodes
It commonly arises from the lid It commonly arises from the lid margin in elderly patients margin in elderly patients
Affects lower & upper eye lids Affects lower & upper eye lids equally equally
Clinical features Clinical features
It may present in two formsIt may present in two forms Nodular scc Nodular scc Ulcerating scc Ulcerating scc Tumour may arise from with free Tumour may arise from with free
existing actinic keratosis or it arises existing actinic keratosis or it arises from as a primary lesions from as a primary lesions
Histology Histology
It is characterized by an irregular It is characterized by an irregular downward proliferation of epidermal downward proliferation of epidermal cells in to the dermis cells in to the dermis
The malignant cell have a whorled The malignant cell have a whorled arrangement forming epithelial arrangement forming epithelial pearls pearls
Treatment Treatment
Same - on the lines of basal cell Same - on the lines of basal cell carcinaoma carcinaoma
Sebaceous cell Sebaceous cell carcinoma carcinoma
It is a rare tumor arising from the It is a rare tumor arising from the Meibomian glands in the tarsal plate Meibomian glands in the tarsal plate
Affects upper lid commonly females Affects upper lid commonly females are more affected than males are more affected than males
It metastasis to the regional It metastasis to the regional lymphnodes lymphnodes
Recurrences are more common Recurrences are more common
Clinical featuresClinical featuresNodular typeNodular type It presents initially as a nodule ( which It presents initially as a nodule ( which
may be mistaken for a chalazion) may be mistaken for a chalazion) Later it grows to form a big growth by Later it grows to form a big growth by
destroying the Meibomian gland orifice destroying the Meibomian gland orifice
Diffuse typeDiffuse type It grows along the lid margin on forms a It grows along the lid margin on forms a
diffuse lid swelling ( which may be diffuse lid swelling ( which may be mistaken for chronic blepharitis)mistaken for chronic blepharitis)
Treatment Treatment
Surgical excision with reconstriction of Surgical excision with reconstriction of the lid the lid
Malignant melanoma Malignant melanoma
It is a rare tumor of the lid ( less It is a rare tumor of the lid ( less than 1%) than 1%)
It may arise from a pre existing It may arise from a pre existing melanotic naevus melanotic naevus
But usually arises as a primary But usually arises as a primary lesion from the melanocytes present lesion from the melanocytes present in the skin in the skin
Clinical features Clinical features
It often appeasers as a flat are slightly It often appeasers as a flat are slightly elevated naevus which has varigated elevated naevus which has varigated pigmentation and irregular borders pigmentation and irregular borders
It may ulcerate and bleed It may ulcerate and bleed
Metastasis:Metastasis: the tumors spread the tumors spread locally as well as to distant sites by locally as well as to distant sites by lymphatic's and blood stream lymphatic's and blood stream
Treatment Treatment
It is a radio resistant tumour It is a radio resistant tumour Radical surgical excision with Radical surgical excision with
reconstruction of the lid reconstruction of the lid Exenteration Exenteration