Post on 22-Jan-2018
Almost all types of tumours arising
from the skin, connective tissue,
glandular tissue, blood vessels,
nerves & muscles can involve the lids.
A few common tumours are listed
here.
CLASSIFICATION1. BENIGN TUMOURS
1. Papillomas
2. Xanthelasma
3. Haemangioma
4. Neurofibroma
2. MALIGNANT TUMOURS
1. Basal-cell Carcinoma
2. Squamous cell Carcinoma
3. Sebaceous Gland Carcinoma
4. Malignant Melanoma (Melanocarcinoma)
1. BENIGN TUMOURS
1. Papillomas:
These are the most common benign tumours arising from the surface epithelium.
i. Squamous papillomas occur in adults, as very slow growing or stationary, raspberry-like growths or as a pedunculate lesion, usually involving the lid margin.
ii. Seborrhoeic keratosis occurs in middle-aged & older persons. Their surface is friable, verrucous & slightly pigmented.
TREATMENT:
Simple excision.
2. Xanthelasma:
These are creamy-yellow plaque-like lesions which frequently involve the skin of upper & lower lids near the inner canthus.
Xanthelasma represents lipid deposits in histiocytes in the dermis of the lid.
These may be associated with diabetes mellitus or high cholesterol levels.
TREATMENT:Excision may be advised for cosmetic
reasons; but recurrences are common.
3. Haemangioma:
Haemangiomas of the lids are common tumours. i. Capillary haemangioma: Is the most common variety which
occurs at or shortly after birth, often grows rapidly & in many cases resolves spontaneously by the age of 7 years.
These may be superficial & bright red in colour or deep & bluish or violet in colour.
They consists of proliferating capillaries & endothelial cells.
TREATMENT:Excision, Intralesional steroid,
Superficial radiotherapy.
ii. Naevus flammeus (port wine stain):
It may occur side-by-side or more
commonly as a part of Sturge-Weber
syndrome.
It consists of dilated vascular channels &
does not grow or regress like the capillary
haemangioma.
iii. Cavernous haemangioma:
Are developmental & usually occur after
first decade of life.
It consists of large endothelium-lined
vascular channels & usually does not show
any regression.
TREATMENT:
4. Neurofibroma:
Lids & orbits are commonly affected in
neurofibromatosis (von Recklinghausen’s
disease).
The tumour is usually plexiform type.
2. MALIGNANT TUMOURS
1. Basal-cell Carcinoma:
It is the commonest malignant tumour of
the lids (90%) usually seen in elderly
people.
It is locally malignant & involves most
commonly lower lid (50%) followed by
medial canthus (25%), upper lid (10-15%)
& outer canthus (5-10%).
TREATMENT:
Surgery, Radiotherapy & Cryotherapy.
CLINICAL FEATURES OF BASAL-
CELL CARCINOMA
It may present in four forms:
Noduloulcerative basal cell carcinoma is the most common presentation.
It starts as a small nodule which undergoes central ulceration with pearly rolled margins.
The tumour grows by burrowing & destroying the tissues locally like a rodent & hence the name rodent ulcer.
Other rare presentations include: non-ulcerated nodular form, sclerosing or morphea type & pigmented basal cell carcinoma.
2. Squamous cell Carcinoma:
It forms the second commonest
malignant tumour of the lid.
Its incidence (5%) is much less than the
basal cell carcinoma.
It commonly arises from the lid margin
(mucocutaneous junction) in elderly
patients.
Affects upper & lower lids equally.
TREATMENT:
Treatment on the lines of basal cell
carcinoma.
CLINICAL FEATURES OF
SQUAMOUS CELL CARCINOMA
It may present in two forms:
An ulcerated growth with elevated &
indurated margins is the common
presentation.
The second form, fungating or
polypoid verrucous lesion without
ulceration, is a rare presentation.
Metastasis: It metastatises in
preauricular & sub-mandibular lymph
nodes.
3. Sebaceous gland Carcinoma:
It is a rare tumour arising from the meibomian glands.
TREATMENT:
Surgical excision with reconstruction of lids; recurrences are common.
CLINICAL FEATURES: It usually presents initially as a nodule
(which may be mistaken for a chalazion).Which then grows to form a big growth.
Rarely, a diffuse tumour along the lid margin may be mistaken as chronic blepharitis.
4. Malignant Melanoma
(Melanocarcinoma):
It is a rare tumour of the lid (less than
1% of all eyelid lesions).
It may arise from a pre-existing naevus,
but usually arises from the beginning from
the melanocytes present in the skin.
TREATMENT:
Surgical excision with reconstruction of
lid.
CLINICAL FEATURES OF
MALIGNANT MELANOMA
(MELANOCARCINOMA): It often appears as a flat or slightly
elevated naevus which has variegated
pigmentation & irregular borders.
It may ulcerate & bleed.
Metastasis: The tumour spreads locally
as well as to distant sites by lymphatics &
blood stream.