MALIGNANT EYELID TUMOURS

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MALIGNANT EYELID TUMOURS
1. Basal cell carcinoma
2. Squamous cell carcinoma
3. Meibomian gland carcinoma
4. Melanoma
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CLINICAL EXAMINATION The following are the three
parts of the clinical examination of a
potentially malignant solid eyelid lesion1.
Palpation of a malignant lesion may show fixation
to deeper structures. Enlargement elf the
corresponding regional lymph nodes would suggest
metastatic spread. The upper eyelid and lateral
canthus drain into the preauricular nodes,
whereas the lower eyelid and medial canthus drain
into the submandibular nodes .2. General
inspection of a malignant tumour may show
ulceration, superficial vascularization and
evidence of progressive growth on serial
examination.3. Slitlamp biomicroscopy of
malignant lesions may detect subtle changes such
as localized destruction of lashes and meibomian
gland orifices, as well as a unilateral localized
area of 'chronic blepharitis'.
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Lymphatic drainage of the eyelids
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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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Squamous cell carcinoma

• Less common but more aggressive than BCC

• Predilection for lower lid

Ulcerative
Nodular

• Hard nodule

• Red base

• Borders sharply defined, indurated
• and elevated

• No surface vascularization

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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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Melanoma
Nodular
Superficial spreading

• Plaque with irregular
• outline

• Blue-black nodule with
• normal surrounding skin

• Variable pigmentation

• May be non-pigmented

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Treatment Options
1. Surgical excision

• Method of choice

2. Radiotherapy

• Small BCC not involving medial
• canthus

3. Cryotherapy

• Small and superficial BCC
• irrespective of location

• Adjunct to surgery in selected cases