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Malignancies 2013

Malignancies 2013






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Malignancies 2013 Malignancies 2013 Presentation Transcript

  • Fritz Allen MDVisionary Ophthalmology March 3rd 2013
  • Review of ocular malignancies focused on - The Eyelids - The Cornea and the Conjunctiva - The Iris
  • Malignancies of the Eyelids
  • 5 more common Eyelid Tumors Basal Cell Carcinomas 92.5% Squamous Cell Carcinomas 4.6% Sebaceous Cell Carcinomas 1.5% Melanomas 1.1% Lymphosarcomas 0.3%
  • 4 Types of Basal cell Carcinomas Nodular Diffuse Superficial Barzexsydrome (autosomal dominant) multiple Basal cell carcinomas
  • Basal cell carcinoma Most common: >90% U.V. exposure, Basal layer of epidermis Fair skinned (Fitzpatrick type I, blue-green irides, Celtic ancestry,) smoking Telangiectasias, pearly borders, central umbilication, alteration lid architecture Medial canthus, lower eyelid most common
  • Cystic BCC
  • Unusual BCC
  • Basal cell carcinoma
  • Sebaceous cell carcinomaIrregularityIndurationUlcerationTelangiectasiaAlteration normal architectureSebaceous secretions inflammation
  • Sebaceous cell carcinoma Appearance not typical of other periocular neoplasms Growth characteristics  Pagetoid spread  Late ulceration  Multifocal origin Upper eyelid Masquerade syndrome  Mimics chalazia, unilateral blepharitis or conjunctivitis  Often associated with lash loss
  • SCCS MimicingChalazion
  • Pigmented lesions Benign features  Uniform color  Symmetric shape  Regular border Malignant features  A- asymmetry  B- borders (irregular)  C- color (non-uniform)  D- diameter > 6mm  E- evolving
  • Diagnosis of Melanoma Recent onset Change in color, shape or size Multi-colored Irregular borders or notching Asymmetric shape Large size: > 6mm Ulceration or hemorrhage
  • Differential Diagnosis Chalazia Benign lesions
  • Chalazion Lipogranulomatous inflammation of sebaceous gland Anterior (Zeis) or posterior (meibomian) Associated MGD and rosacea Pyogenic granuloma if erupts posteriorly Multiple lesions, recurrences Treatment: heat, Doxycycline, omega-3 fatty acids, I&D, steroid injection Limited role for topical gtts/ung
  • Hordeola Internal: meibomian gland
  • Apocrine hydrocystoma– Solitary smooth cyst near lid margin– Common middle age and older– Translucent, may be bluish– Adenoma of gland of Moll– Often called a „sudoriferous cyst‟
  • Benign eyelid lesions Benign epithelial proliferations “papillomas”
  • Papilloma Pedunculated flesh- colored tumor Descriptive, not diagnostic term Used to describe  Acrochordon  “skin tag”  Intradermal nevus  Seborrheic keratosis  Verruca vulgaris (wart)  Actinic keratosis
  • Seborrheic keratosis Greasy, keratotic plaque with “stuck on” appearance Early – small 1-3 mm well outlined, oval flat lesion Later – larger, thicker more verrucous lesions Varigated color, light to dark brown Multiple keratin plugs on surface Usually multiple lesions Extremely common Benign proliferation of normal epithelial cells Shave biopsy or excision
  • Acrochordon “skin tag” “Fibroepithelioma” Pedunculated flesh- colored tumor Common on eyelid, neck, axillae, groin Small, 2-3 mm, often multiple Snip off at base
  • Cutaneous horn Skin colored horn-like projection of keratin Descriptive not diagnostic Overlying a variety of lesions:  Seborrheic keratosis  Verruca vulgaris  Nevus  Actinic keratosis  Keratoacanthoma  Squamous cell carcinoma  Basal cell carcinoma Biopsy of lesion for diagnosis
  • Epidermal inclusion cyst Whitish dermal – or subcutaneous, round cyst Contains cheesy, desquamated keratin Not a “sebaceous cyst” May become infected or rupture and cause inflammation Must excise, destroy, or marsupialize lining or will recur
  • Epidermal inclusion cyst
  • Tumors of the Cornea andConjunctiva
  • Conjunctival Intraepithelial Neoplasia(CIN) Bowen‟s disease Conjunctival dysplasia Intraepithelial epithelioma Dyskeratosis
  • Etiology of CIN Uncertain, usually unilateral in fair-skinned men in mid 60‟s Smoking Human Papillo Virus (HPV)
  • Management and Treatment Local excision and Cryotherapy with double or triple freeze-thaw Interferon
  • Invasive Squamous Cell Carcinoma Replacement of normal epithelium by bizarre pleomorphic cells 10-40% recurrence
  • Less Common Neoplasms of theConjunctiva Mucoepidermoid Carcinoma (anywhere from the conjunctiva) Spindle Cell Carcinoma Sebaceous Cell Carcinoma (50- 60% Upper lids, 20% Lower lids) Asians Melanocytic Tumors
  • Miscellaneous Conditions Kaposi‟s Sarcoma (in immunosupressed , AIDS) Lymphoid Tumors Granulomas
  • Tumors of the Iris Nevi and Melanomas (most common primary tumors of the iris 49-72% of all iris tumors Melanocytomas (Magnocellular nevus) Melanocytosis(Nevus of Ota)
  • Pathology 13% Melanomas (Spindle cells or epithelial cells) 87% Benign Nevi Medium age 40-50 yo More common in light Irides, rare in black and Asian
  • Examination and Evaluation Slit Lamp, Gonioscopy OCT/UBM Fluoresceine angiogram
  • Management Conservative approach (observation and growth documentation) Iridectomy and Iridocyclectomy(no glaucoma surgery in proven malignant iris tumors)
  • Differential Diagnosis Benign Nevi (less than 3mm in diameter-1mm thickness) Iris Cyst (OCT) Iris nodules (Sarcoidosis, Tuberculosis) Hamartomas (Lisch nodules) Metastatic lesions
  • Congenital Disorders NEUROFIBROMATOSIS NF1 Café-au-lait spots Iris Lisch nodules
  • Neoplastic Disorders Iris metastasis from lung carcinoma