Lid Tumour

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Lid Tumour
Clinical
Any abnormal growth in eyelids constitutes
eyelid tumours. They can be benign or
malignant in nature. All eyelid lesions
should be evaluated to rule out malignancy.
Malignant lid tumours can present with
ulceration, bleeding, irregular shape, irregular
margin, abnormal colour, lack of pain and loss
of eyelid margin. If malignancy is suspected
biopsy should be performed to confirm
diagnosis. The tumours can be benign and
malignant.
I. Benign nodules and cyst:
1. Chalazion: A chalazion (meibomian
cyst) is a chronic, sterile, granulomatous
inflammatory lesion caused by retained
sebaceous secretion leaking from the
meibomian or other sebaceous glands into
adjacent stroma. A chalazion secondarily
infected is referred to as an internal
hordeolum. Presentation is at any age
with a gradually enlarging painless
nodule. Very occasionally a large upper lid
chalazion may press on the cornea, induce
astigmatism and cause blurred vision.
Surgery done is incision and curettage.
The eyelid is everted with a special clamp,
the chalazion is incised vertically and its
contents curetted through the tarsal plate.
2. Epidermal inclusion cyst: It is usually
caused by implantation of epidermis into
the dermis following trauma or surgery. It
is a slow-growing, round, firm, superficial
or subcutaneous lesion containing keratin.
3. Epidermoid cyst: It is uncommon and
usually developmental, occurring along
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embryonic lines of closure. It is similar in
appearance to an epidermal inclusion cyst.
Dermoid cyst: It is usually subcutaneous
or deeper and is typically attached to the
periosteum at the lateral end of the brow.
It is caused by skin sequestered during
embryonic development.
Sebaceous cyst: It is caused by a blocked
pilosebaceous follicle and contains
sebaceous secretions. It is only rarely
found on the eyelid although it may
occasionally occur at the inner canthus.
Cyst of Zeis: It is a small, non-translucent
cyst on the anterior lid margin arising
from obstructed sebaceous glands
associated with the eyelash follicle.
Cyst of Moll: It is a small retention cyst of
the lid margin apocrine glands. It appears
as a round, non-tender, translucent fluidfilled lesion on the anterior lid margin that
may have a bluish tinge.
II. Benign epidermal tumours
1. Squamous cell papilloma: A squamous
cell papilloma (fibroepithelial polyp)
is a very common condition that has a
variable clinical appearance but common
histological features. It presents as a fleshcoloured, narrow based pedunculated
lesion or a broad-based (sessile) lesion
which may exhibit a raspberry-like
surface. Treatment involves simple
excision.
2. Basal cell papilloma: Basal cell papilloma
(seborrhoeic keratosis, seborrhoeic wart)
Chalazion - bump on the eyelid; Blepharoconjunctivitis - conjunctivitis with inlammation of the eyelid; Malignant - harmful
A R A V I N D
E Y E
C A R E
S Y S T E M
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is a common, slow-growing condition
found on the face of elderly individuals.
It presents as a discrete, greasy, brown
plaque with a friable verrucous surface
and a ‘stuck on’ appearance. Treatment
involves shave excision of flat lesions and
excision of pedunculated lesions.
3. Melanocytic nevus: Large lesions have
potential for malignant transformation
of up to 15%. It presents usually as small
lesion with uniform colour. A kissing or
split nevus is a rare type of congenital
nevus that involves the upper and lower
eyelid and may occasionally contain
numerous hairs. Treatment, if necessary,
involves complete surgical excision.
III. Malignant eyelid tumours: Most common
eyelid tumours are:
• Basal cell carcinoma
• Sebaceous cell/meibomian gland
carcinoma
• Squamous cell carcinoma
• Malignant melanoma
1. Basal cell carcinoma:
Most common
malignant tumour of
eyelid. It is usually
seen in old age. It
commonly involves
lower lid and medial
canthus. It can
present as nodule with central ulceration.
It spreads and destroys surrounding tissue
like a rodent (rat), so it is also called rodent
ulcer. Treatment is total surgical excision with
3mm surrounding normal skin with tumour
free margins in frozen section. Sometimes
radiotherapy may be required.
2. Sebaceous cell / Meibomian gland carcinoma:
Most common eyelid
tumour in India. It can
present as nodule with
yellow colour. It can be
mistaken for a chalazion
(recurrent) or chronic
blepharoconjunctivitis.
The presence of yellowish material in tumour
is characteristic of sebaceous cell carcinoma.
Treatment includes wide margin surgical
excision with tumour free margins in frozen
section.
3. Squamous cell carcinoma:
Usually occurs in
old age. Chronic
sunlight exposure is
a risk factor. It can
present as nodule,
plaque or ulcerative
lesion which can easily bleed. Sometimes it
can spread to lymph nodes. Treatment is total
surgical excision with tumour free margins in
frozen section. Sometimes radiotherapy may
be required.
4. Malignant melanoma:
It is a rare lid tumour.
It can arise from
pre-existing nevus.
It presents as flat or
elevated pigmented
lesion with irregular
border. It may
ulcerate and bleed. Treatment is total surgical
excision with tumour free margins in frozen
section.
- Ms. R. Sundari
Orbit -OT Supervisor, Aravind - Madurai
Benign - not harmful; Excision - removal; Lesion - wound; Nevus - a birthmark in the form of a raised red patch.
Compassion July - Sep, 2014

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