Abnormal Ocular Conditions - SESSION 1 part 1

What is a lesion?

any damage or abnormality

What are some common benign lesions that can be found on eyelid?

Xanthelasma

Papilloma

Skin tags

Haemangioma

Retention cysts

Milia

What is xanthelasma?

soft yellow plaques on eye lid

- BENIGN

- Doesn't need referral

- usually medial upper and lower eyelids, often bilateral

- lipid and cholesterol deposits (high lipid levels in blood)

What is a squamous cell papilloma?

Viral wart

- common in adults

- sessile (Fixed at the base) or pedunculated (loosely attached onto another part of the lesion)

- excessive convoluted epithelium with central fibrovascular core. (Blood vessel in the middle of them with epithelium around - raspberry like appearance)

- BENIGN

- can get multiple of few of any size

- Can be removed.

What is a basal cell papilloma?

AKA seborrheic keratosis

- Very common

- can be smooth/waxy/warty surface

- Slow growing, not painful or tender

- can be flat or raised plaque

- colors include: yellow, grey, light brown, dark brown or mixed.

- can be removed

- BENIGN

What is dermatitis papulosa Nigra?

multiple small black or dark brown papules on face and neck

- found in patients with a dark skin colour

- number of it increases with age

- identical to small seborrheic keratoses

- BENIGN

What are skin tags?

Small, benign outgrowths of the skin that look like flaps

- variable in size, shape colour and number

- the cause is unclear - made up of clusters of collagen and blood vessels surrounded by skin

- They are harmless and BENIGN

What is a capillary haemangioma?

- AKA strawberry naevus

- evident in the neonatal period (newborns, then it can grow and usually disappears by the time the child is 5 years old)

- it can be in the skin or eye

- its worth a letter to the gp as there could be systemic associations.

- occasionally on top eyelid so can cause a droopy lid. If it blocks the visual axis then it may effect the development of vision. could cause astigmatism.

What is vascular malformation?

port wine stain

present at birth, may become more prominent with time

- 5% are associated with sturge weber syndrome in which 30% of patients get gluacoma (damage to optic nerve).

What is retention cysts?

Small round and non tender cysts

- on eyelid margin due to a blocked gland.

- cyst of zeis = sebacious, white cheesy material

- cyst of moll = clear fliud filled

- sebacious cysts can occur anywhere on the skin.

- can get it removed

What is milia?

Tiny white/yellow dome shaped cysts

- common in new born (called milk spots) but can occur at any age

- Trapped keratin

- occur in multiple numbers on nose, chin, cheeks and around the eyes.

What is a naevi?

- moles on skin and eyelid

- can be congenital or acquired

- pigmented or non pigmented

- flat or raised

- somtimes they have hairs or can be a warty surface or smooth

- malignant transformation is rare.

What are some premalignant tumours?

Actinic keratosis

Keratocanthoma

What is actinic keratosis?

a pre-malignant lesion

- scaly rough skin

- red pink, brown or skin coloured

- occurs in older ages or patients with a history of sun exposure

- may give rise to squamous cell carcinoma.

- ocassionally papillomatous or cutaneous horn.

What is a cutaneous horn?

Keratin projection

- arise from benign, premaligant or maligant

- 10% associated with squanous cell carcinoma

- removed in the hospital

- referred promptly.

What is a kertocanthoma?

- Premalignant

- rapidly enlarges throughout months and then regresses OR evolves into squamous cell carcinoma

- Volcano shaped with a keratin plug

- arises from hair follicle skin cells

- can transform into malignant

- refer promptly

What are some malignant lesions?

Basal cell carcinoma

Squamous cell carcinoma

Sebaceous gland carcinoma

Malignant melanoma

Kaposi's sacroma

Merkel cell carcinoma

What is basal cell carcinoma?

most common periocular (around eye) malignancy

- slow growing, often painless but ulcerated

- dont spread throughout the body but invade locally slowly.

- change the contour and skin around it, loss of eyelashed etc.

What are the different types of basal cell carcinoma?

- nodular

- ulcerative

- sclerosing

What is the management for BCC?

urgent referral

- low risk skin cancer (wont spread rapidly), take photographs.

secondary care: surgery and histology

What is squamous cell carcinoma?

- can evoke inflammatory response

- may irritate or itch and bleed.

- can look similar to BCC but more aggressive

- symptomatic

- more likely to spread than BCC

What is the management for SCC?

Urgent referral, low risk skin cancer, photograph documentation

secondary care: surgery & histology

What is a malignant melanoma?

very rare

- arise from nowhere or malignant transformation from naevus

- Itching, bleeding, pigmentary changes, increasing size

- 50% are non pigmented

Where does sebacious gland carcinoma originate from?

Mebomian glands or gland of zeis - highly rare malignant. Lump in eyelid but can be clearly seen when the eyelid is inverted.

What is Merkel cell carcinoma?

rare, highly malignant

What is Kaposi's sarcoma?

Cancerous, dark bluish-purple lesions that involve blood vessels

- associated with HIV/AIDS

How can you tell the difference between benign & malignant?

Taking patient history by using key questions such as 'how long has it been there', ' has it crusted or bled', ' Any history of skin cancer'.

What are the signs of malignant vs benign?

Malignant:

- new

- increasing in size

- ulceration

- new blood vessels in and around lesion

- crusts

Benign:

- Long standing

- static in size

- Smooth

- Doesn't bleed with minor trauma

- no crusts

- does not destroy eyelash follicles