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

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

Frequency of location of basal cell carcinoma

Lower lid - 70%

Medial canthus - 15%

Upper lid - 10%

Lateral canthus - 5%

Nodular basal cell carcinoma

Early

Shiny, indurated nodule Surface vascularization Slow progression

Advanced

May destroy large portion of eyelid

Ulcerative basal cell carcinoma

(rodent ulcer)

Early

Chronic ulceration

Advanced

Raised rolled edges and bleeding

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

Histology of basal cell carcinoma

Downgrowth from epidermis

of small, dark atypical basal cells

Peripheral palisading

Cell nests in fibrous stroma

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

Prominent nuclei and

abundant acidophilic

cytoplasm

Variable sized groups of atypical

epithelial cells within dermis

Histology of squamous cell carcinoma

Keratin pearl

Meibomian gland carcinoma

Spreading

Nodular

Very rare aggressive tumour with 10% mortality Predilection for upper lid

Hard nodule; may

mimic a chalazion

Very large tumour

Diffuse thickening of lid

margin and loss of lashes

Conjunctival invasion; may

mimic chronic conjunctivitis

Histology of meibomian gland carcinoma

Cells stain positive for fat

Cells contain foamy vacuolated

cytoplasm and large

hyperchromatic nuclei

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

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

Merkel cell carcinoma

Highly malignant with frequent metastases at presentation Fast-growing, violaceous, well-demarcated nodule Intact overlying skin Predilection for upper eyelid

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

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

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