Lids and Lashes (pt 6)

Potential Dx for “my eyelid is bleeding”

• Actinic keratosis

• Basal cell carcinoma

• Squamous cell carcinoma

• Kaposi sarcoma

• Merkel cell

Malignant conditions

• Basal cell carcinoma

• Squamous cell carcinoma

• Merkel cell

• Kaposi Sarcoma

Actinic Keratosis

Precancerous lid lesion

Actinic keratosis risk factors

• Elderly

• Chronic UV exposure

Actinic keratosis clinical findings

Round, flat, scaly, red lesion found on hands and cheeks

Basal cell carcinoma

Cancer of epidermis basal cells that have a low metastatic rate and is locally invasive

Most commonly found in the head and neck, commonly found in lower lid, most common lid carcinoma

Nodular, noduloulcerative, sclerosing types

Basal cell carcinoma risk factors

• Older males

• Fair skin

• Immunosuppression

• Chronic UV exposure

Shared characteristics among the 3 types of basal cell carcinomas

• Ulceration and bleeding

• Irregular borders

• Lid architecture change

• Firm

• No pain

Nodular basal cell carcinoma hallmark signs

Shiny nodule with dilated surface blood vessels, no ulceration

Noduloulcerative basal cell carcinoma hallmark signs

Raised and rolled edge with central ulceration and dilated surface blood vessels

Sclerosing basal cell carcinoma hallmark signs

Hardens plaque that mimics chronic bleph

Basal cell carcinoma hallmark signs

Firm lesion that has dilated surface blood vessels

Squamous cell carcinoma

Invasive malignancy of skin squamous cells

2nd most common skin cancer, commonly found on lower lid, metastasis is uncommon but will spread to lymph nodes

Nodular and ulcerating types

Squamous cell carcinoma risk factors

• Elderly

• Fair skin

• Immunocompromised

• Chronic UV exposure

• Precancerous lesion

Precursors to squamous cell carcinoma

• Actinic keratosis

• Keratoacanthoma

• Cutaneous horn

Shared characteristics among squamous cell carcinoma types

• Ulceration

• Firm

• Lid architecture change

• Hyperkeratosis

Physical difference between squamous and basal cell carcinoma

Squamous cell doesn’t have dilated surface blood vessels

Nodular squamous cell carcinoma hallmark signs

Hyperkeratotic that may crust or fissure

Ulcerating squamous cell carcinoma hallmark signs

Red base with hardened everted edges

Squamous cell carcinoma hallmark signs

Firm lesion without dilated blood vessels

Kaposi sarcoma

Rare malignancy found in cells that line blood vessels or lymph nodes caused by human herpesvirus 8 in an immunocompromised pts

Does not metastasize

Types of Kaposi sarcoma

Classic: Affects hands and feet

Endemic African: Affects lower extremities and lymph system

Immunocompromised: Affects those who received an organ transplant

Epidemic: Affects HIV/AIDs pts

Kaposi sarcoma clinical findings

• Elevated purple lesions

• Thickened lids and edema from lymph obstruction

• Not painful or hot

Kaposi sarcoma complications

• Mechanical ptosis

• Entropion/ectropion

• Lagophthalmos

• Trichiasis

How to tell a chalazion from kaposi sarcoma

Chalazions do not turn purple

Kaposi sarcoma Tx

• Surgical excision (may reoccur)

• Cryotherapy

• Chemotherapy with biological agents (organ transplant)

• Anti-retroviral therapy (HIV/AIDs)

• Radiation therapy

Kaposi sarcoma hallmark signs

Purple lesion

Merkel cell

Rare aggressive neuroendocrine malignancy of the skin

Merkel cell risk factors

• Elderly men

• Caucasian

• Immunocompromised

• Chronic UV exposure

• Concurrent malignancies

Merkel cell clinical findings

• Red/pink nodule on upper lid

• Ulcerated or overlying telangectasia

Merkel cell complications

• Madarosis

• Lid architecture changes

• Metastasis (30%)

Merkel cell Tx

• Surgical excision

• Radiation therapy

• Chemotherapy

Merkel cell hallmark signs

Red/pink upper lid nodular lesion