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Malignancies 2013

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  • 1. Fritz Allen MDVisionary 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% Melanomas1.1% Lymphosarcomas0.3% 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, Basallayer of epidermis Fair skinned (Fitzpatricktype I, blue-green irides,Celtic ancestry,) smoking Telangiectasias, pearlyborders, centralumbilication, alteration lidarchitecture Medial canthus, lowereyelid most common 7. Cystic BCC 8. Unusual BCC 9. Basal cell carcinoma 10. Sebaceous cell carcinomaIrregularityIndurationUlcerationTelangiectasiaAlteration normalarchitectureSebaceous secretionsinflammation 11. Sebaceous cell carcinoma Appearance not typical ofother periocular neoplasms Growth characteristics Pagetoid spread Late ulceration Multifocal origin Upper eyelid Masquerade syndrome Mimics chalazia, unilateralblepharitis 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 orsize Multi-colored Irregular borders ornotching Asymmetric shape Large size: > 6mm Ulceration or hemorrhage 15. Differential Diagnosis Chalazia Benign lesions 16. Chalazion Lipogranulomatousinflammation of sebaceousgland Anterior (Zeis) or posterior(meibomian) Associated MGD and rosacea Pyogenic granuloma if eruptsposteriorly 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 nearlid margin Common middle age andolder Translucent, may be bluish Adenoma of gland of Moll Often called asudoriferous cyst 19. Benign eyelid lesions Benign epithelialproliferations papillomas 20. Papilloma Pedunculated flesh-colored tumor Descriptive, not diagnosticterm Used to describe Acrochordon skin tag Intradermal nevus Seborrheic keratosis Verruca vulgaris (wart) Actinic keratosis 21. Seborrheic keratosis Greasy, keratotic plaque withstuck on appearance Early small 1-3 mm welloutlined, oval flat lesion Later larger, thicker moreverrucous lesions Varigated color, light to darkbrown Multiple keratin plugs on surface Usually multiple lesions Extremely common Benign proliferation of normalepithelial cells Shave biopsy or excision 22. Acrochordon skin tag Fibroepithelioma Pedunculated flesh-colored tumor Common on eyelid, neck,axillae, groin Small, 2-3 mm, oftenmultiple Snip off at base 23. Cutaneous horn Skin colored horn-likeprojection 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 orsubcutaneous, round cyst Contains cheesy,desquamated keratin Not a sebaceous cyst May become infected orrupture and causeinflammation Must excise, destroy, ormarsupialize lining or willrecur 25. Epidermal inclusion cyst 26. Tumors of the Cornea andConjunctiva 27. Conjunctival Intraepithelial Neoplasia(CIN) Bowens disease Conjunctival dysplasia Intraepithelial epithelioma Dyskeratosis 28. Etiology of CIN Uncertain, usually unilateral in fair-skinned men inmid 60s Smoking Human Papillo Virus (HPV) 29. Management and Treatment Local excision and Cryotherapywith double or triple freeze-thaw Interferon 30. Invasive Squamous Cell Carcinoma Replacement of normal epithelium by bizarrepleomorphic cells 10-40% recurrence 31. Less Common Neoplasms of theConjunctiva Mucoepidermoid Carcinoma(anywhere from the conjunctiva) Spindle Cell Carcinoma Sebaceous Cell Carcinoma (50-60% Upper lids, 20% Lower lids)Asians Melanocytic Tumors 32. Miscellaneous Conditions Kaposis Sarcoma (inimmunosupressed , AIDS) Lymphoid Tumors Granulomas 33. Tumors of the Iris Nevi and Melanomas (most common primarytumors of the iris 49-72% of all iris tumors Melanocytomas (Magnocellular nevus) Melanocytosis(Nevus of Ota) 34. 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 35. Examination and Evaluation Slit Lamp, Gonioscopy OCT/UBM Fluoresceine angiogram 36. Management Conservative approach (observation and growth documentation) Iridectomy and Iridocyclectomy(no glaucoma surgery in proven malignant iris tumors) 37. Differential Diagnosis Benign Nevi (less than 3mm in diameter-1mmthickness) Iris Cyst (OCT) Iris nodules (Sarcoidosis, Tuberculosis) Hamartomas (Lisch nodules) Metastatic lesions 38. Congenital Disorders NEUROFIBROMATOSIS NF1Caf-au-lait spots Iris Lisch nodules 39. Neoplastic Disorders Iris metastasis from lung carcinoma