The document reviews ocular malignancies of the eyelids, cornea, conjunctiva, and iris. It discusses the most common eyelid tumors including basal cell carcinomas, squamous cell carcinomas, sebaceous cell carcinomas, and melanomas. It also reviews conjunctival intraepithelial neoplasia, invasive squamous cell carcinoma of the conjunctiva, and less common conjunctival neoplasms. Finally, it discusses tumors of the iris including nevi, melanomas, and other benign and malignant lesions.

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