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![Sebaceous gland carcinoma
• General features
• Very rare slowly-growing tumour . More common in
elderly Females.
• It usually arises from the meibomian glands, glands of
Zeis or from sebaceous glands in the caruncle.
• Site - upper eyelid [ meibomian glands numerous].
• The clinical diagnosis of SGC is frequently difficult
because:
• -in its early stages, external signs of malignancy may be
subtle.
• so that the tumour may resemble a chalazion or
blepharitis.](https://image.slidesharecdn.com/malignanteyelidtumours-180919141720/85/Malignant-eyelid-tumours-28-320.jpg)
![Laissez-faire [Let it do]
• Full reconstruction of the defect created by
tumour removal may not always be required.
• In the laissez-faire approach the wound edges
are approximated as far as possible,
• and the defect is allowed to granulate and
heal by secondary intention.
• Even large defects can often achieve a
satisfactory outcome with time.](https://image.slidesharecdn.com/malignanteyelidtumours-180919141720/85/Malignant-eyelid-tumours-68-320.jpg)
![Sebaceous gland carcinoma
• General features
• Very rare slowly-growing tumour . More common in
elderly Females.
• It usually arises from the meibomian glands, glands of
Zeis or from sebaceous glands in the caruncle.
• Site - upper eyelid [ meibomian glands numerous].
• The clinical diagnosis of SGC is frequently difficult
because:
• -in its early stages, external signs of malignancy may be
subtle.
• so that the tumour may resemble a chalazion or
blepharitis.](https://image.slidesharecdn.com/malignanteyelidtumours-180919141720/75/Malignant-eyelid-tumours-28-2048.jpg)
![Laissez-faire [Let it do]
• Full reconstruction of the defect created by
tumour removal may not always be required.
• In the laissez-faire approach the wound edges
are approximated as far as possible,
• and the defect is allowed to granulate and
heal by secondary intention.
• Even large defects can often achieve a
satisfactory outcome with time.](https://image.slidesharecdn.com/malignanteyelidtumours-180919141720/75/Malignant-eyelid-tumours-68-2048.jpg)
More Related Content
Similar to Malignant eyelid tumours
Malignant eyelid tumours
- 1. Malignant tumours ofEyelids Dr. M. Tanuja Phani Kumari
- 2. • The mostcommon eyelid cancer is basal cell carcinoma. • In the western hemisphere it accounts for more than 85% of all eyelid malignancies. • However, in China the incidence seems to be closer to 50% of eyelid malignancies. • Squamous cell carcinoma and sebaceous gland carcinoma combine to make up most of the other 50%: • whereas, in the western countries, these two tumors make up less than 10% of all eyelid malignancies.
- 3. • Two othertumors, lymphoma and malignant melanoma, occur on the eyelids with much less frequency. • But must be considered because of their serious potential. • There are some other rare tumours. • All of these tumours can be lethal but cure rates are high if the cancers are recognized and treated early enough to prevent spread beyond the eyelids
- 4. • Basal cellcarcinoma is the easiest to cure because it grows slowly and causes damage by direct extension and very rarely metastasizes. • Squamous cell carcinoma metastasizes on occasion. • Sebaceous cell carcinoma and malignant melanoma have a high rate of metastasis; • Therefore, early treatment is essential in these cases. • Lymphoma may present in the ocular area and proper treatment may prevent spread to the rest of the body.
- 5. Basal cell carcinoma •Basal cell carcinoma is the most common malignancy of the eyelids. • It occurs most frequently on the lower eyelid and the medial canthus. • the tumor distribution was as follows: lower lid, 53%; medial canthus, 27%; upper lid, 1.2%; and lateral canthus, 8%.1 Another study had these statistics: lower lid, 66%; upper lid, 16%; medial canthus, 13%; lateral canthus, 3%.
- 6. • Age: BCCtumour is most often in 6th, 7th and 8th decades of life. • In 5-15 % of patients the age is 20-40 years.
- 7. • General featuresof BCC : • The most common human malignancy. • The most common malignant eyelid tumour in elderly patients. • Risk factors : fair skin, inability to tan • chronic exposure to sunlight • Site : lower eyelid, followed in relative frequency by the medial canthus, upper eyelid and lateral canthus.
- 8. • It isslow-growing and locally invasive but non- metastasizing. • It is prone to invade the orbit and sinuses. • It has greatest risk of recurrence- hence needs aggressive treatment. • Histology • Arises from basal layer of the epidermis and proliferate downwards. • Palisading pattern at the periphery tumour lobule with squamous differentiation - production of keratin - hyperkeratotic type of BCC. • Also shows sebaceous and adenoid differentiation.
- 9. . A nodular basalcell carcinoma showing peripheral palisading.
- 10. • Clinical types •Clues : ulceration, lack of tenderness, induration, irregular • borders and destruction of lid margin architecture. 1 Nodular BCC – • shiny, firm, pearly nodule with small dilated blood vessels on its surface. 2 Noduloulcerative BCC (rodent ulcer) • - central ulceration, • - pearly raised rolled edges • - Dilated and irregular blood vessels (telangiectasis)
- 11. • 3 SclerosingBCC (morphoeic) • -infiltrates laterally beneath the epidermis as an indurated plaque . • -it simulates a localized area of chronic blepharitis. • A morpheaform basal cell carcinoma demonstrating typical fine strands of basophilic malignant basal cells
- 12. An ulcerative BCCinvolving the lower lid margin Note the fi ne telangiectatic vessels on its surface and central dense pigmentation very classical of BCC
- 13. The whole upperand lower lids are involved. The BCC has extended into the orbit, causing a fungating mass An ulcerative lesion involving the lateral canthus
- 14.
- 15. A Small pigmentedrodent ulcer over lower lid margin Its extension into the tarsal plate
- 16. A very largeforehead BCC infested with maggots Exenteration of the orbital contents has been performed
- 17. Exenterated specimen Orbit hasbeen covered with split skin graft
- 18. 3 months afterexenteration of the orbit
- 19. Squamous cell carcinoma •General features • SCC is a much less common , more aggressive tumour - metastasis to regional lymph nodes – • More seen in elderly individuals. • Careful surveillance of regional lymph nodes is therefore an important aspect of initial management. • Perineural spread to the intracranial cavity via the orbit occurs. • SCC accounts for 5–10% of eyelid malignancies • They arise de novo / or on pre-existing actinic keratosis / carcinoma in situ.
- 20. • Immuno compromisedpatients such as those with AIDS or following renal transplants are at increased risk. • Site - lower eyelid and the lid margin. • Risk Factors : fair complexion. • history of chronic sun exposure. • The diagnosis of SCC may be difficult because keratoacanthoma and cutaneous horn may reveal histological evidence of invasive SCC at deeper levels of sectioning.
- 21. • Histology : Arisefrom squamous cell layer of the epidermis. • Atypical epithelial cells with prominent nuclei and abundant eosinophilic cytoplasm within the dermis. • Well-differentiated tumours -show keratin ‘pearls’ and intercellular bridges (desmosomes).
- 22. SCC showing keratinpearls
- 23. • Clinical types •1 Nodular SCC - hyperkeratotic nodule develop • crusting erosions and fissures • 2 Ulcerating SCC - red base and sharply defined, • indurated and everted borders. • 3 Cutaneous horn with underlying invasive SCC.
- 24. Nodulo ulcerative presentation ofupper lid marginal SCC Close up view of the same
- 25. Nodulo ulcerative SCCof lower lid margin Close up view of the same
- 26. Lower lid SCCwith distorted lid margin with complete loss of eyelashes Everted view of the case showing tarsal plate involvement
- 27. An ulcerated SCCupper lid lesion. The lid appears grossly thickened. The patient presented with sudden onset of severe bleeding from the base of the ulcerated lesion An enlarged view of the ulcer, The bleeding has stopped as the result of a temporary clot formation. These ulcers may bleed profusely and recurrently
- 28. Sebaceous gland carcinoma •General features • Very rare slowly-growing tumour . More common in elderly Females. • It usually arises from the meibomian glands, glands of Zeis or from sebaceous glands in the caruncle. • Site - upper eyelid [ meibomian glands numerous]. • The clinical diagnosis of SGC is frequently difficult because: • -in its early stages, external signs of malignancy may be subtle. • so that the tumour may resemble a chalazion or blepharitis.
- 29. • A yellowishmaterial within the tumour is highly suggestive of SGC. • There are difficulties in diagnosis and delay in treatment. Adverse prognostic features of SGC : • upper lid involvement * • tumour size of 10 mm or more* • Duration of symptoms of over 6 months*
- 30. • Histology : •Lobules of cells with pale foamy vacuolated lipid containing cytoplasm and large hyperchromatic nuclei. Clinical types 1 Nodular SGC – • discrete, hard nodule, most commonly within the upper tarsal plate, that may exhibit yellow discoloration due to the presence of lipid . • It may masquerade as a chalazion , • In cases of unusual consistency we should go for full- thickness resection and histological examination.
- 31. 2 .Spreading SGC •it infiltrates into the dermis and causes a diffuse thickening of the lid margin that may result in loss of lashes. • It may be mistaken for ‘chronic blepharitis’. 3 Pagetoid spread • it refers to extension of the tumour within epithelium including the palpebral, forniceal or bulbar conjunctiva. • mistaken diagnosis of an inflammatory condition.
- 32. Sebaceous carcinoma showing cellswith frothy sebaceous cytoplasm. Sebaceous carcinoma in a comedo pattern. Malignant sebaceous cells are organized around a central area of necrosis (circled).
- 33. Nodular lesion inthe upper eyelid with loss of eye lashes over the lesion . This is a very suspicious lesion
- 34. Classically, the lesionof eyelid adenocarcinoma is a firm, painless, indurated mass or ulceration associated with the loss of cilia, in an area that has been treated for recurrent chalazion Very large, hard lump on the upper lid. Sebaceous gland (adeno) carcinoma should always be suspected in cases such as this
- 35. Large fungating sebaceous gland(adeno) carcinoma mass from the lid margin A large papulonodular adenocarcinoma mass originating from the upper lid margin
- 36. Malignant melanoma • Pigmentationis a hallmark of melanoma • Features suggestive of melanoma include • --recent onset of a pigmented lesion, • --change in an existing pigmented lesion, • -- irregular margins, • --asymmetrical shape, • -- colour change or presence of multiple colours, • --diameter > 6 mm in diameter.
- 37. • Lentigo maligna-(melanoma in situ intraepidermal melanoma /Hutchinson freckle) • Uncommon condition that develops in sun- damaged skin in elderly individuals. • Malignant change may occur, with infiltration of the dermis.
- 38. • Histology -intraepidermal proliferation of spindle- shaped atypical melanocytes that replace the basal layer of the epidermis. • Signs: • A slowly expanding pigmented macule with an irregular border • Nodular thickening and areas of irregular pigmentation; • Which are highly suggestive of malignant transformation • Treatment is usually by excision.
- 40. • Melanoma • Histology: shows large atypical melanocytes within the dermis • Signs of different types : 1. Superficial spreading melanoma is characterized by a • plaque with an irregular outline and variable pigmentation 2. Nodular melanoma is typically a blue-black nodule surrounded by normal skin Treatment is usually by wide excision and may include --local lymph node removal.
- 41. Malignant melanoma showingthe epithelial surface and nests of melanocytes with a nevus-like configuration, showing deep invasion of atypical (malignant) melanocytes into the dermis.
- 42. Merkel cell carcinoma •Rare Fast-growing tumour which typically affects the elderly. • Although Merkel cells lie within the epidermis, the tumour appears to arise from the dermis. • Difficulty in diagnosis and delay in treatment. • The tumour is highly malignant and • 50% of patients have metastatic spread at the time of presentation.
- 43. • Histology :- • sheets of cells with scanty cytoplasm, • round or oval nuclei and • numerous mitotic figures Signs: • A violaceous, well-demarcated nodule over intact • overlying skin, • mostly at upper eyelid. Treatment is by excision, frequently combined with chemotherapy.
- 45. Elevated lid marginMCC. Note the prominent telangiectasia
- 46. Reddish, nontender nodular MCCover the medial part of the upper lid Rapidly growing lobulated reddish nodule over the lid margin highly suspicious of MCC
- 47. Kaposi sarcoma • Kaposisarcoma is a vascular tumour • which typically affects patients with the acquired immune deficiency syndrome (AIDS). • Many patients have advanced systemic disease although in some instances the tumour may be the only clinical manifestation of HIV infection.
- 48. • Histology :shows proliferating spindle cells, • vascular channels and inflammatory cells within the dermis . • Signs: A pink, red-violet to brown lesion which may be mistaken for a haematoma or a naevus. • Treatment is by radiotherapy or excision.
- 50. Purplish red noduleover the lower lid skin in an HIV-positive patient is suggestive of Kaposi sarcoma Cluster of bright-red and highly vascular structures over the lid skin of patient (HIV-positive) is suggestive of Kaposi sarcoma
- 51. Rare predisposing conditions •Xeroderma pigmentosum AR disease • - skin damage on exposure to sunlight, progressive cutaneous pigmentation abnormalities • bird-like facies. • development of (BCC), (SCC) and melanoma, which may be multiple. • Conjunctival malignancies have also been reported.
- 52. • Gorlin–Goltz syndrome(naevoid basal cell carcinoma syndrome) AD • - Extensive congenital deformities of the eye, face, bone and CNS. • - multiple small BCC during the 2nd decade of life • and are predisposed to medulloblastoma, breast carcinoma and Hodgkin lymphoma.
- 53. • Muir–Torre syndromeAD • - Cutaneous tumours include BCC, sebaceous gland carcinoma (SGC) and • keratoacanthoma. • - Colorectal & genitourinary carcinoma is the most common systemic tumour.
- 54. Treatment • (a) Incisionalbiopsy- using a blade or a biopsy punch, • in which only part of the lesion is removed to • allow histological diagnosis. • (b) Excisional biopsy- in which the entire lesion is • removed and a histological diagnosis made; the • latter may be: 1. Shave excision using a blade to remove • shallow epithelial tumours, such as papillomas • and seborrhoeic keratosis. 2 . Full-thickness skin excision for • tumours that are not confined to the epidermis.
- 55. Surgical excision • Aimis to remove the entire tumour with preservation of as much normal tissue as possible. • Smaller tumours can be removed via an excision biopsy • and the defect closed directly, whilst awaiting histological confirmation of complete clearance. • More radical surgical excision is required for large BCC • and aggressive tumours such as SCC, SGC and Malignant melanoma.
- 56. • It isnecessary to ensure complete clearance of tumour prior to undertaking any reconstruction. • Faster confirmation can be achieved using either frozen section control or micrographic surgery, and • reconstruction can then take place on the same day.
- 57. • 1. Standardfrozen section : • Histological examination of the margins of the excised specimen at the time of surgery to ensure that they are tumour-free. • If No tumour cells eyelid is reconstructed; • If Tumour cells are present , further excision is performed until the site is tumour free.
- 59. • 2. MOHSmicrographic surgery • Developed by Frederich E Mohs. • - Layered excision of the tumour is done. • Processing of each layer enables a map of the edges of the tumour to be developed. • Further tissue is taken in any area where tumour is still present until clearance is achieved. • It is time-consuming, but maximizes the chances of total tumour excision.
- 60. • It hasminimizing sacrifice of normal tissue. • It is Useful technique for tumours that grow diffusely and have indefinite margins with finger-like extensions, such as • sclerosing BCC, SCC, • recurrent tumours • and those involving the medial or lateral canthi
- 62. Reconstruction • Depends onthe extent of tissue removed & • whether this is full- or partial-thickness. • If one of the lamellae has been sacrificed during excision of the tumour, it must be reconstructed with similar tissue. 1. Small defects involving less than one-third of the eyelid are closed directly provided the surrounding tissue is sufficiently elastic – • approximation of the cut edges is done.
- 63. • If necessary,a lateral cantholysis - to mobilize • additional tissue has to be done if defect cannot be re- approximated 2 Moderate size defects involving up to half of the eyelid • may require a flap • (e.g. Tenzel semicircular) for closure.
- 64. TENZEL Myocutaneous flaptechnique
- 65. 3. Large defectsinvolving > half of the eyelid : • ◊ Posterior lamellar reconstruction • an upper lid free tarsal graft, buccal mucous • membrane or hard palate graft is prepared and grafted over the defect. • ◊ Anterior lamellar reconstruction • - skin advancement, a local skin flap or a free • skin graft (At least one reconstructed lamella requires its own blood supply to maximize the viability of any free graft).
- 66. Cutler –Beard procedure Step1: after excision of the carcinoma, almost entire upper lid is removed and a lower lid full thickness flap is mobilized 4 mm below the lash line. Step 2 : the flap is pulled under the lid bridge and the conjunctiva is sutured to the cut margin. The anterior lamella is sutured to the cut margin. More sutures are applied to bridge the gap. Step 3 : the lid is seperated after 6 weeks. Step 4 : upper and lower lids are formed.
- 67.
- 68. Laissez-faire [Let itdo] • Full reconstruction of the defect created by tumour removal may not always be required. • In the laissez-faire approach the wound edges are approximated as far as possible, • and the defect is allowed to granulate and heal by secondary intention. • Even large defects can often achieve a satisfactory outcome with time.
- 69.