MALIGNANT EYELID TUMOURS

1. Basal cell carcinoma

2. Squamous cell carcinoma

3. Meibomian gland carcinoma4. 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 carcinomaEarly

• 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 epidermisof 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; maymimic a chalazion

Very large tumour

Diffuse thickening of lid margin and loss of lashes

Conjunctival invasion; maymimic chronic conjunctivitis

Histology of meibomian gland carcinoma

Cells stain positive for fatCells contain foamy vacuolatedcytoplasm 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