1. Fritz Allen MD
Visionary Ophthalmology
March 3rd 2013

2. Review of ocular malignancies
focused on - The Eyelids
- The Cornea and the
Conjunctiva
- The Iris

3. Malignancies of the Eyelids

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. 4 Types of Basal cell Carcinomas
 Nodular
 Diffuse
 Superficial
 Barzexsydrome (autosomal dominant) multiple
Basal cell carcinomas

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. Cystic BCC

8. Unusual BCC

9. Basal cell carcinoma

10. Sebaceous cell carcinoma
Irregularity
Induration
Ulceration
Telangiectasia
Alteration normal
architecture
Sebaceous secretions
inflammation

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. SCCS
MimicingChalazion

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. 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. Differential Diagnosis
 Chalazia
 Benign lesions

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. Hordeola
Internal: meibomian gland

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. Benign eyelid lesions
 Benign epithelial
proliferations
 “papillomas”

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. 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. 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. 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. 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. Epidermal inclusion cyst

28. Tumors of the Cornea and
Conjunctiva

29. Conjunctival Intraepithelial Neoplasia
(CIN)
 Bowen‟s disease
 Conjunctival dysplasia
 Intraepithelial epithelioma
 Dyskeratosis

33. Etiology of CIN
 Uncertain, usually unilateral in fair-skinned men in
mid 60‟s
 Smoking
 Human Papillo Virus (HPV)

34. Management and Treatment
 Local excision and Cryotherapy
with double or triple freeze-thaw
 Interferon

35. Invasive Squamous Cell Carcinoma
 Replacement of normal epithelium by bizarre
pleomorphic cells
 10-40% recurrence

36. Less Common Neoplasms of the
Conjunctiva
 Mucoepidermoid Carcinoma
(anywhere from the conjunctiva)
 Spindle Cell Carcinoma
 Sebaceous Cell Carcinoma (50-
60% Upper lids, 20% Lower lids)
Asians
 Melanocytic Tumors

39. Miscellaneous Conditions
 Kaposi‟s Sarcoma (in
immunosupressed , AIDS)
 Lymphoid Tumors
 Granulomas

46. 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)

47. 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

51. Examination and Evaluation
 Slit Lamp, Gonioscopy
 OCT/UBM
 Fluoresceine angiogram

52. Management
 Conservative approach
(observation and growth documentation)
 Iridectomy and
Iridocyclectomy(no glaucoma surgery
in proven malignant iris tumors)

56. Differential Diagnosis
 Benign Nevi (less than 3mm in diameter-1mm
thickness)
 Iris Cyst (OCT)
 Iris nodules (Sarcoidosis, Tuberculosis)
 Hamartomas (Lisch nodules)
 Metastatic lesions

58. Congenital Disorders
NEUROFIBROMATOSIS NF1
Café-au-lait spots Iris Lisch nodules

59. Neoplastic Disorders
Iris metastasis from lung carcinoma