10 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 4. 5. 6. 7. 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 11 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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