Malignancies 2013

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  • SentinelVx
  • Malignancies 2013

    1. 1. Fritz Allen MDVisionary Ophthalmology March 3rd 2013
    2. 2. Review of ocular malignancies focused on - The Eyelids - The Cornea and the Conjunctiva - The Iris
    3. 3. Malignancies of the Eyelids
    4. 4. 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%
    5. 5. 4 Types of Basal cell Carcinomas Nodular Diffuse Superficial Barzexsydrome (autosomal dominant) multiple Basal cell carcinomas
    6. 6. 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
    7. 7. Cystic BCC
    8. 8. Unusual BCC
    9. 9. Basal cell carcinoma
    10. 10. Sebaceous cell carcinomaIrregularityIndurationUlcerationTelangiectasiaAlteration normal architectureSebaceous secretions inflammation
    11. 11. 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
    12. 12. SCCS MimicingChalazion
    13. 13. 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
    14. 14. 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
    15. 15. Differential Diagnosis Chalazia Benign lesions
    16. 16. 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
    17. 17. Hordeola Internal: meibomian gland
    18. 18. 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‟
    19. 19. Benign eyelid lesions Benign epithelial proliferations “papillomas”
    20. 20. Papilloma Pedunculated flesh- colored tumor Descriptive, not diagnostic term Used to describe  Acrochordon  “skin tag”  Intradermal nevus  Seborrheic keratosis  Verruca vulgaris (wart)  Actinic keratosis
    21. 21. 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
    22. 22. Acrochordon “skin tag” “Fibroepithelioma” Pedunculated flesh- colored tumor Common on eyelid, neck, axillae, groin Small, 2-3 mm, often multiple Snip off at base
    23. 23. 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
    24. 24. 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
    25. 25. Epidermal inclusion cyst
    26. 26. Tumors of the Cornea andConjunctiva
    27. 27. Conjunctival Intraepithelial Neoplasia(CIN) Bowen‟s disease Conjunctival dysplasia Intraepithelial epithelioma Dyskeratosis
    28. 28. Etiology of CIN Uncertain, usually unilateral in fair-skinned men in mid 60‟s Smoking Human Papillo Virus (HPV)
    29. 29. Management and Treatment Local excision and Cryotherapy with double or triple freeze-thaw Interferon
    30. 30. Invasive Squamous Cell Carcinoma Replacement of normal epithelium by bizarre pleomorphic cells 10-40% recurrence
    31. 31. 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
    32. 32. Miscellaneous Conditions Kaposi‟s Sarcoma (in immunosupressed , AIDS) Lymphoid Tumors Granulomas
    33. 33. 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)
    34. 34. 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
    35. 35. Examination and Evaluation Slit Lamp, Gonioscopy OCT/UBM Fluoresceine angiogram
    36. 36. Management Conservative approach (observation and growth documentation) Iridectomy and Iridocyclectomy(no glaucoma surgery in proven malignant iris tumors)
    37. 37. Differential Diagnosis Benign Nevi (less than 3mm in diameter-1mm thickness) Iris Cyst (OCT) Iris nodules (Sarcoidosis, Tuberculosis) Hamartomas (Lisch nodules) Metastatic lesions
    38. 38. Congenital Disorders NEUROFIBROMATOSIS NF1 Café-au-lait spots Iris Lisch nodules
    39. 39. Neoplastic Disorders Iris metastasis from lung carcinoma

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