Benign tumors of eyeld
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Transcript of Benign tumors of eyeld
BENIGN TUMORS
OF EYELID
-10M2368
CLASSIFICATION
BbBBRBBENIBRR BENIGN MALIGNANT PRE-MALIGNANT
BENIGN TUMORS:
I. PAPILLOMASII. XANTHELASMAIII. HEMANGIOMAIV. NEURFIBROMAV. KERATOACANTHOMAVI. NAEVIVII. DERMOID CYST
PAPILLOMA Most common benign tumors arising from
the surface epithelium. Occurs in two forms >Squamous cell Papilloma >Basal cell Papilloma [ Seborrhoeic Keratosis]
SQUAMOUS CELL PAPILLOMA Outgrowth of fibrovascular connective tissue covered by
irregular keratinized stratified squamous epithelium No predilection to race or gender
Appearance Variable presentations “Skin tag” type: narrow base, pedunculated, skin colored Board base with “raspberry like” appearance Differentiate from viral wart (human papilloma virus)
Management Removed by excision
PEDUNCULATED
SESSILE
BASAL CELL PAPILLOMA Expansion of the squamous epithelium stemming from
basal cell proliferation Common in the elderly Usually develop on the head, neck, or trunk
Appearance Round “coin-like” lesion with “stuck-on” appearance Up to 2.5 cm diameter Slightly raised and crusty; surface is friable, verrucous
and slightly pigmented (Tan to dark brown in color) Variety of textures: granular to velvety
Management No treatment required except for cosmetic reasons or if
they become irritated Removed by excision
XANTHELASMAAggregation of lipid filled macrophages at the level of the dermis Common and frequently bilateral. Middle aged and the elderly. Associated with elevated cholesterol especially when
occurring in younger individuals with Arcus senilis.
Appearance Yellowish subcutaneous plaque Usually on the medial portion of the eyelids Often multiple
Management Removed for cosmetic reasons Usually excised with carbon dioxide or argon laser Recurrence suggests persistently elevated cholesterol
Appearance:
>Yellowish subcutaneous plaque
>Usually on the medial portion of the eyelids
>Often multiple
HEMANGIOMA
Hemangiomas of the lids are common tumors.
Occurs in three forms: 1. Capillary hemangioma. 2. Naevus flammeus(Port-wine stain). 3. Cavernous hemangioma.
CAPILLARY HEMANGIOMA Most common variety. Occurs at/shortly after birth and grows rapidly.
APPEARANCE: Superficial, bright red in colour (strawberry naevus) / deep bluish / violet in colour.
: consist of proliferating capillaries and endothelial cells. TREATMENT: Resolves spontaneously by the age of 7 yrs. Excision for small tumors. Intralesional steroid( Triamcinolone) Alternate day high dose steroid therapy & Superficial Radiotherapy.
Starts as small, red lesion,most frequently on upper lid
Blanches with pressure and swells on crying
NAEVUS FLAMMEUS• May occur commonly in Sturge-
Weber syndrome.( associated with port-wine stains of the face, glaucoma, seizures, mental retardation)
• Consists of dilated vascular channels
• Does not regress like capillary hemanigioma
• LASER TREATMENT:
CAVERNOUS HEMANGIOMA Occurs after first decade of
life
commonly present as solitary, unilateral lesions
Consists of large endothelium lined vascular channels
Does not show any regression
TREATMENT:
INVERTED FOLLICULAR KERATOSIS Rare and often rapid growing lesion arising from a hair
follicle Typically older males
Appearance Non pigmented papilloma at the lid margin Up to 1 cm diameter Histologically similar to basal cell papilloma, but
with deeper extension into the dermis
Management Deep excision Recurrence is common if not completely
removed
INVERTED FOLLICULAR KERATOSIS
NEUROFIBROMA Abnormal proliferation of Schwann cells, fibroblasts, and
axons Solitary lesions occur in adults 25% associated with neurofibromatosis-1 Children with neurofibromatosis-1 are affected by
diffuse lesions
Appearance Characteristic S shaped lesion Typically located on the upper lid
Management Solitary lesions removed by excision Diffuse lesions are more difficult to remove
KERATOACANTHOMA Rare and rapidly growing variant of actinic keratosis Higher occurrence in patients on immunosuppressive therapy following kidney transplants
Appearance Initially appears as a pink hyperkeratotic lesion usually on
the lower lid After a period of rapid growth, remains stable for
several months Then begins to involute and a keratin filled crater
often forms Complete involution can occur after a year leaving
a residual scar
Management Usually excised with cryotherapy or radiotherapy
MELANOCYTIC NEVUSTumor composed of cells derived from arrested epidermal melanocytes Acquired and congenital forms
TYPES: Junctional type occurs in the young Compound type occurs in middle age Intradermal type most common and occurs in the elderly
Management Removal for cosmetic reasons or if malignancy is
suspected Excision may need to be followed by reconstruction
depending on location and size
Junctional Nevus:: Uniform brown macule or plaque
Compound Nevus:Uniform, light to dark brown, raised papule
Intradermal Nevus:: Papillomatous with little to no pigment. Associated with dilated vessels and protruding lashes
DERMOID CYST A dermoid is an overgrowth of normal, non-
cancerous tissue in an abnormal location. There are two main types: orbital dermoid is typically found in
association with the bones of the eye socket.
epibulbar dermoid is found on the surface of the eye, either at the junction of the cornea and sclera (limbal epibulbar dermoid) or posteriorly on the eye (posterior epibulbar dermoid or lipodermoid).
DERMOID CYST OF EYELID
PRE-MALIGNANT TUMORS
ACTINIC KERATOSIS XERODERMA PIGMENTOSA
DEFINITION: Slow growing keratinization of the epithelium from excessive sun exposure
May transform into squamous cell carcinoma Elderly individuals with lightly pigmented skin Rarely develops on the eyelid Common on the scalp, ears, forehead, and backs of
hands
Appearance Rough, dry, and scaly plaque that is flat or slightly
raised, distinct boarders Often multiple lesions in a single area that coalesce May be skin colored to dark brown
ACTINIC KERATOSIS
MANAGEMENT:
1.BIOPSY: DEFINITIVE DIAGNOSIS2.FROZEN (CRYOTHERAPY) OR EXCISED
XERODERMA PIGMENTOSA
Autosomal recessive disease Damage on exposure to sunlight Characterstic features Progressive cutaneous pigmentation Bird-like facies is typical. Predisposition to develop lid tumors
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