Management of Malignant Eyelid Lesions



Management of Malignant Eyelid Lesions


Tanya T. Khan, MD



EVALUATION OF LESIONS



  • History



    • Time course


    • Waxing/waning appearance


    • History of bleeding or scabbing


    • Beware of the “recurrent chalazion” — if a lesion recurs in the same region, do not hesitate to biopsy.


  • Examination



    • Clinical appearance ranges from dramatic to subtle presentation.


    • Appearance of lesion



      • Size


      • Color


      • Texture


      • Location


      • Depth


    • Look for disruption of the normal eyelid architecture.



      • Ulceration


      • Pigmentation


      • Madarosis


      • Feeder vessels


      • Posterior involvement along the palpebral conjunctiva


MOST COMMON EYELID MALIGNANCIES



  • Basal cell carcinoma (BCC)



    • Appearance — varied (Figure 16.1)



      • Classically a pearly nodule with rolled borders, central ulceration


      • Flat, scaly, red macule


      • White, waxy, scar-like lesion


      • Usually nonpigmented but occasionally pigmented







        FIGURE 16.1. A, Basal cell carcinoma with the classic appearance of a pearly nodule with rolled borders and central ulceration. B, Nodular basal cell carcinoma of the right lower lid with madarosis. C, Infiltrative basal cell carcinoma of the left lower lid.


    • Most common eyelid malignancy


    • Accounts for over 90% of malignant eyelid lesions


    • Locally invasive, very low risk for metastasis


    • Lower eyelid most common site (followed by medial canthus, upper eyelid, lateral canthus)


    • Histologic variants



      • Nodular


      • Infiltrative/morpheaform — higher recurrence rate


    • Risk factors



      • Sun exposure (ultraviolet radiation)


      • Fair skin


      • Immunosuppression


      • Xeroderma pigmentosum


      • Basal cell nevus syndrome


  • Squamous cell carcinoma (SCC)



    • Appearance (Figure 16.2)



      • Reddish macule or papule with scaly, crusted surface


    • Second most common eyelid malignancy


    • Accounts for less than 5% of malignant eyelid lesions


    • Metastatic rate of 5% to 15%, predilection for perineural invasion


    • Lower eyelid and medial canthus are most common sites.


    • Risk factors



      • Fair skin


      • Sun exposure (UV radiation)


      • Actinic keratosis (1% per year)


      • Smoking


      • Human papillomavirus (HPV)


      • Immunosuppression







        FIGURE 16.2. A, Squamous cell carcinoma of the right medial canthus presenting in an area of previously treated actinic keratosis. B, Squamous cell carcinoma of the left lateral canthus presenting as an erythematous, scaly macule with crusting. C, Neglected squamous cell carcinoma of the left upper lid with significant hyperkeratosis.


  • Sebaceous cell carcinoma

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May 10, 2021 | Posted by in OPHTHALMOLOGY | Comments Off on Management of Malignant Eyelid Lesions

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