MALIGNANT EYELID TUMOURS

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MALIGNANT EYELID TUMOURS
1. Basal cell carcinoma
2. Squamous cell carcinoma
3. Meibomian gland carcinoma
4. Melanoma
5. Kaposi sarcoma
6. Merkel cell carcinoma 7. Treatment
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Basal Cell Carcinoma - Important Facts
1. Most common human malignancy
2. Usually affects the elderly
3. Slow-growing, locally invasive
4. Does not metastasize
5. 90 occur on head and neck
6. Of these 10 involve eyelids
7. Accounts for 90 of eyelid malignancies
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Frequency of location of basal cell carcinoma
Lower lid - 70
Medial canthus - 15
Upper lid - 10
Lateral canthus - 5
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Nodular basal cell carcinoma
Early
Advanced

• Slow progression

• Shiny, indurated nodule

• May destroy large portion of eyelid

• Surface vascularization

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Ulcerative basal cell carcinoma (rodent ulcer)
Early
Advanced
Chronic ulceration
Raised rolled edges and bleeding
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Sclerosing basal cell carcinoma
Advanced
Early

• Spreads radially beneath normal
• epidermis

• Indurated plaque with loss of lashes

• May mimic chronic blepharitis

• Margins impossible to delineate

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Histology of basal cell carcinoma
Cell nests in fibrous stroma
Downgrowth from epidermis of small, dark atypical
basal cells
Peripheral palisading
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Squamous cell carcinoma

• Less common but more aggressive than BCC

• May arise de novo or from actinic keratosis

• Predilection for lower lid

Ulcerative
Nodular

• Hard, hyperkeratotic nodule

• Red base

• May develop crusting fissures

• Borders sharply defined, indurated
• and elevated

• No surface vascularization

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Histology of squamous cell carcinoma
Prominent nuclei and abundant acidophilic
cytoplasm
Variable sized groups of atypical epithelial
cells within dermis
Keratin pearl
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Meibomian gland carcinoma

• Very rare aggressive tumour with 10 mortality

• Predilection for upper lid

Nodular
Hard nodule may mimic a chalazion
Very large tumour
Spreading
Diffuse thickening of lid margin and loss of
lashes
Conjunctival invasion may mimic chronic
conjunctivitis
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Histology of meibomian gland carcinoma
Cells stain positive for fat
Cells contain foamy vacuolated cytoplasm and
large hyperchromatic nuclei
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Melanoma
Nodular
Superficial spreading
From lentigo maligna (Hutchinson freckle)

• Plaque with irregular
• outline

• Affects elderly

• Blue-black nodule with
• normal surrounding skin

• Slowly expanding
• pigmented macule

• Variable pigmentation

• May be non-pigmented

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Kaposi sarcoma

• Vascular tumour occurring in patients with AIDS

• Usually associated with advanced disease

• Very sensitive to radiotherapy

Advanced
Early
May ulcerate and bleed
Pink, red-violet lesion
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Merkel cell carcinoma

• Highly malignant with frequent metastases at
  presentation

• Fast-growing, violaceous, well-demarcated nodule

• Intact overlying skin

• Predilection for upper eyelid

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Treatment Options
1. Surgical excision

• Method of choice

2. Radiotherapy

• Small BCC not involving medial
• canthus

• Kaposi sarcoma

3. Cryotherapy

• Small and superficial BCC
• irrespective of location

• Adjunct to surgery in selected cases

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Lower eyelid reconstruction following tumour
excision
a
b
Direct closure of small defect
a
b
b
Mustarde cheek rotation flap for large defect
Tenzel flap for moderate defect
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Eyelid-sharing procedure
Extensive sclerosing BCC
Total excision of lower lid
Tarsoconjunctival flap
Appearance after healing
Reconstruction of posterior lamella
Reconstruction of anterior lamella with
skin graft