TUMOURS OF TUMOURS OF THE LIDSTHE LIDS

Dr. Christina SamuelDr. Christina Samuel

Common benign tumors of Common benign tumors of the lids the lids

A. CystsA. Cysts Dermoid cyst Dermoid cyst Sebaceous cystSebaceous cyst Meibomian cyst Meibomian cyst B. Tumors B. Tumors - Naevus or mole - Naevus or mole - Papilloma - Papilloma - Hemangioma- Hemangioma- Neuro fibroma - Neuro fibroma - Granuloma - Granuloma - Warts - Warts - Xanthalosma - Xanthalosma - Molascum contagiasm - Molascum contagiasm

Dermoid Dermoid

Presents since birth and came grow Presents since birth and came grow in to a large size in to a large size

Typically found at the outer orbital Typically found at the outer orbital margin but may be else were also margin but may be else were also

The tumor is fixed to the underlying The tumor is fixed to the underlying bone – zygomatico temporal suturebone – zygomatico temporal suture

the skin our the tumour is freely the skin our the tumour is freely movable movable

Treatment Treatment

Surgical excision to be removed Surgical excision to be removed intact intact

Cauterization Cauterization

Sebaceous cyst Sebaceous cyst

It looks like a dermoid It looks like a dermoid

TThe differentiating features from the he differentiating features from the dermoiddermoid

The sebaceous cyst is not attached firmly to The sebaceous cyst is not attached firmly to the underlying structures. But freely movable the underlying structures. But freely movable

A pigmented point on the skin were the skin A pigmented point on the skin were the skin is adherent to the underlying cyst is adherent to the underlying cyst

Unlike a dermoid it can be present any were Unlike a dermoid it can be present any were in the lid and is commonly seen at the inner in the lid and is commonly seen at the inner port of the upper eye lid port of the upper eye lid

Naevous or mole Naevous or mole

Commonly seen at the muco Commonly seen at the muco cutaneous junction of the lid cutaneous junction of the lid

It may affect either the skin or It may affect either the skin or conjunctiva of the lid conjunctiva of the lid

It may undergo malignant It may undergo malignant transformation if untreated transformation if untreated

Neuro fibroma Neuro fibroma

Multiple pedunculated growth of Multiple pedunculated growth of varying may be seen on the skin of the varying may be seen on the skin of the lid lid

It may be seen on the eye lid as a part It may be seen on the eye lid as a part of generalised neuro fibrofibrometosis of generalised neuro fibrofibrometosis (Von reckling hausen’s diseases) (Von reckling hausen’s diseases)

It may cause mechanical ptosisIt may cause mechanical ptosis Small multiple tumor are distributed Small multiple tumor are distributed

along the hyper trophied nerves along the hyper trophied nerves

Papilloma (sqamous Papilloma (sqamous papilloma) papilloma)

It is the most common benign tumor of It is the most common benign tumor of the eye lid the eye lid

It affects patients older then 30 yrs due to It affects patients older then 30 yrs due to exposure to Ultra violet rays exposure to Ultra violet rays

It may present as a round multi lobular It may present as a round multi lobular lesion with a central vascular core lesion with a central vascular core

Treatment:Treatment: Electrocautery Electrocautery Chemical caterization Chemical caterization CoCo22 laser ablation laser ablation

Hemangioma Hemangioma

There are two types There are two types Capillary hemangioma Capillary hemangioma

Manifests as bright red or portwine Manifests as bright red or portwine spots – composed of dilated capillaries spots – composed of dilated capillaries

Cavernous hemagioma Cavernous hemagioma Manifests as large dilated and Manifests as large dilated and

anastomosing subcutaneous venous anastomosing subcutaneous venous channels with are blue in colour channels with are blue in colour

In general In general

Hemangiomas are found along the Hemangiomas are found along the distribution of first and second distribution of first and second divisions are the trigeminal nerve divisions are the trigeminal nerve

Hemangiomas of the lid is often Hemangiomas of the lid is often associated hemangioma of the associated hemangioma of the coroid, leptomeninges and coroid, leptomeninges and hydrophthalmos (Sturge-weber hydrophthalmos (Sturge-weber syndrome) syndrome)

Treatment Treatment

Small hemangioma – Spontaneous Small hemangioma – Spontaneous involution involution

Large hemangiomasLarge hemangiomas Intra lesion injection of a mixture of Intra lesion injection of a mixture of

40mg of triamcinolone acetonide & 6mg 40mg of triamcinolone acetonide & 6mg of beta methasone sodium phosphate of beta methasone sodium phosphate

Systemic Corticosteroids Systemic Corticosteroids RadiotheraphyRadiotheraphy Surgical excision Surgical excision

Xanthelasma Xanthelasma

It affects elderly woman It affects elderly woman Associated with diabetics and hyper Associated with diabetics and hyper

Cholestero laemia Cholestero laemia It appears as slightly raised yellow It appears as slightly raised yellow

wrinkled plaques near the inner cantus wrinkled plaques near the inner cantus

Treatment:Treatment: Surgical excision Surgical excision Cryotheraphy Cryotheraphy

Malignant tumors of the Malignant tumors of the eye lideye lid

There are three types There are three types 1. Carcinomas1. Carcinomas 2. Sarcomas 2. Sarcomas 3. Malignant melanoma 3. Malignant melanoma

Carcinomas Carcinomas

1. Basal cell carcinomas 1. Basal cell carcinomas

2. Squamous cell carcinoma 2. Squamous cell carcinoma

3. Sebaceous cell carcinoma 3. Sebaceous cell carcinoma

Sarcomas Sarcomas

1. Kaposi sarcoma – in AIDS patients 1. Kaposi sarcoma – in AIDS patients

2. Reticular tumors 2. Reticular tumors

- Lymphoma - Lymphoma

- Lympho sarcoma - Lympho sarcoma

Basal cell carcinoma Basal cell carcinoma (rodent ulcer) (rodent ulcer)

It is the commonest malignant epithelial It is the commonest malignant epithelial growth of the eye lid (90%)growth of the eye lid (90%)

Risk factors Risk factors People with fair skin People with fair skin Chronic exposure to sunlightChronic exposure to sunlight

Rarely occurs before 40yrs of age Rarely occurs before 40yrs of age Shows predilection for the medial cantus Shows predilection for the medial cantus

in the lower lid in the lower lid It comments as a small nodule which It comments as a small nodule which

ulcerates in its central part ulcerates in its central part

Ulcers Ulcers

Edges are raised an indurate Edges are raised an indurate Spreads very slowly, extending under Spreads very slowly, extending under

the skin in all directions and the skin in all directions and penetrating deeply like a Rodent penetrating deeply like a Rodent (hence the name) (hence the name)

The surrounding structures are The surrounding structures are gradually destroyed an the lids, orbit gradually destroyed an the lids, orbit and the bones are invadedand the bones are invaded

The growth is locally malignant, The growth is locally malignant, lymphnodes are not affected lymphnodes are not affected

CLINICAL TYPES:CLINICAL TYPES:

NODULARNODULAR ULCERATIVEULCERATIVE SCLEROSINGSCLEROSING

NODULAR TYPENODULAR TYPE

Shiny ,translucent,firm raised Shiny ,translucent,firm raised indurated nodule with small dilated indurated nodule with small dilated blood vessels on its surfaceblood vessels on its surface

Initially growth is slow but the Initially growth is slow but the subsequent growth is faster subsequent growth is faster

ULCERATIVE TYPEULCERATIVE TYPE

Raised lesion with rolled borders Raised lesion with rolled borders and an ulcerated centreand an ulcerated centre

Dilated blood vessels may course Dilated blood vessels may course from the surfacefrom the surface

Bleeding is common after relatively Bleeding is common after relatively trivial trauma.trivial trauma.

SCLEROSING TYPESCLEROSING TYPE

Originates in the epidermis but soon Originates in the epidermis but soon spreads to the dermis spreads to the dermis

Occurs as a flat indurated plaque,not Occurs as a flat indurated plaque,not associated with telangiectatic blood associated with telangiectatic blood vessels of the surfacevessels of the surface

Occasionally simulate chronic Occasionally simulate chronic blepharitisblepharitis

treatmenttreatment

Most small BCC require excision Most small BCC require excision with a 3 mm excision of the tissue with a 3 mm excision of the tissue which look clinically normalwhich look clinically normal

Standard frozen section involves per Standard frozen section involves per operative examination of tissue at operative examination of tissue at the margin of the excised tissuethe margin of the excised tissue

SQUAMOUS CELL SQUAMOUS CELL CARCINOMACARCINOMA

It is much less common but It is much less common but potentially aggressive tumour than potentially aggressive tumour than BCC with metastasis to the regional BCC with metastasis to the regional lymphnodes lymphnodes

It commonly arises from the lid It commonly arises from the lid margin in elderly patients margin in elderly patients

Affects lower & upper eye lids Affects lower & upper eye lids equally equally

Clinical features Clinical features

It may present in two formsIt may present in two forms Nodular scc Nodular scc Ulcerating scc Ulcerating scc Tumour may arise from with free Tumour may arise from with free

existing actinic keratosis or it arises existing actinic keratosis or it arises from as a primary lesions from as a primary lesions

Histology Histology

It is characterized by an irregular It is characterized by an irregular downward proliferation of epidermal downward proliferation of epidermal cells in to the dermis cells in to the dermis

The malignant cell have a whorled The malignant cell have a whorled arrangement forming epithelial arrangement forming epithelial pearls pearls

Treatment Treatment

Same - on the lines of basal cell Same - on the lines of basal cell carcinaoma carcinaoma

Sebaceous cell Sebaceous cell carcinoma carcinoma

It is a rare tumor arising from the It is a rare tumor arising from the Meibomian glands in the tarsal plate Meibomian glands in the tarsal plate

Affects upper lid commonly females Affects upper lid commonly females are more affected than males are more affected than males

It metastasis to the regional It metastasis to the regional lymphnodes lymphnodes

Recurrences are more common Recurrences are more common

Clinical featuresClinical featuresNodular typeNodular type It presents initially as a nodule ( which It presents initially as a nodule ( which

may be mistaken for a chalazion) may be mistaken for a chalazion) Later it grows to form a big growth by Later it grows to form a big growth by

destroying the Meibomian gland orifice destroying the Meibomian gland orifice

Diffuse typeDiffuse type It grows along the lid margin on forms a It grows along the lid margin on forms a

diffuse lid swelling ( which may be diffuse lid swelling ( which may be mistaken for chronic blepharitis)mistaken for chronic blepharitis)

Treatment Treatment

Surgical excision with reconstriction of Surgical excision with reconstriction of the lid the lid

Malignant melanoma Malignant melanoma

It is a rare tumor of the lid ( less It is a rare tumor of the lid ( less than 1%) than 1%)

It may arise from a pre existing It may arise from a pre existing melanotic naevus melanotic naevus

But usually arises as a primary But usually arises as a primary lesion from the melanocytes present lesion from the melanocytes present in the skin in the skin

Clinical features Clinical features

It often appeasers as a flat are slightly It often appeasers as a flat are slightly elevated naevus which has varigated elevated naevus which has varigated pigmentation and irregular borders pigmentation and irregular borders

It may ulcerate and bleed It may ulcerate and bleed

Metastasis:Metastasis: the tumors spread the tumors spread locally as well as to distant sites by locally as well as to distant sites by lymphatic's and blood stream lymphatic's and blood stream

Treatment Treatment

It is a radio resistant tumour It is a radio resistant tumour Radical surgical excision with Radical surgical excision with

reconstruction of the lid reconstruction of the lid Exenteration Exenteration